Therapeutic Effects of Statins: Promising drug for Topical and Transdermal Administration.

Statins are HMG-CoA reductase inhibitors and decrease plasma low-density lipoprotein cholesterol (LDL-C) levels. They are well tolerated, and because of their LDL-C-lowering effect, they are utilized to decrease the risk of atherosclerosis and cardiovascular disease. However, statins have pleiotropic effects, including immunomodulatory, anti-inflammatory, antioxidant, and anticancer. Currently, oral administration is the only Food and Drug Administration (FDA)-approved route of administration for statins. However, other administration routes have demonstrated promising results in different pre-clinical and clinical studies. For instance, statins also seem beneficial in dermatitis, psoriasis, vitiligo, hirsutism, uremic pruritus, and graft-versus-host disease. Topically applied statins have been studied to treat seborrhea, acne, rhinophyma, and rosacea. They also have beneficial effects in contact dermatitis and wound healing in animal studies, (HIV) infection, osseointegration, porokeratosis, and some ophthalmologic diseases. Topical and transdermal application of statins is a non-invasive drug administration method that has shown significant results in bypassing the first-pass metabolism in the liver, thereby reducing possible adverse effects. This study reviews the multifaceted molecular and cellular impacts of statins, their topical and transdermal application, novel delivery systems, such as nanosystems for topical and transdermal administration and the challenges concerning this approach.

Antioxidant Effects of Statins by Modulating Nrf2 and Nrf2/HO-1 Signaling in Different Diseases.

Statins are competitive inhibitors of hydroxymethylglutaryl-CoA (HMG-CoA) reductase and have been used to treat elevated low-density lipoprotein cholesterol (LDL-C) for almost four decades. Antioxidant and anti-inflammatory properties which are independent of the lipid-lowering effects of statins, i.e., their pleiotropic effects, might be beneficial in the prevention or treatment of many diseases. This review discusses the antioxidant effects of statins achieved by modulating the nuclear factor erythroid 2 related factor 2/ heme oxygenase-1 (Nrf2/HO-1) pathway in different organs and diseases. Nrf2 and other proteins involved in the Nrf2/HO-1 signaling pathway have a crucial role in cellular responses to oxidative stress, which is a risk factor for ASCVD. Statins can significantly increase the DNA-binding activity of Nrf2 and induce the expression of its target genes, such as HO-1 and glutathione peroxidase) GPx, (thus protecting the cells against oxidative stress. Antioxidant and anti-inflammatory properties of statins, which are independent of their lipid-lowering effects, could be partly explained by the modulation of the Nrf2/HO-1 pathway.

COMBINED TREATMENT WITH BEVACIZUMAB AND TRIAMCINOLONE ACETONIDE FOR MACULAR EDEMA DUE TO RETINAL VEIN OCCLUSION.

The purpose of this study was to determine the efficacy of combined intravitreal bevacizumab and triamcinolone in the treatment of macular edema due to retinal vein occlusion. A prospective randomized trial was conducted in the Department of Ophthalmology, Osijek University Hospital Centre in Osijek including 51 patients divided into three groups depending on the drug received. The first group received 1.25 mg intravitreal bevacizumab, the second group received 1 mg intravitreal triamcinolone, and the third group received a combination of 1.25 mg bevacizumab and 1 mg intravitreal triamcinolone on the same day. Changes in the central macular thickness, intraocular pressure and visual acuity were monitored during the follow up period. The retinal perfusion status was evaluated by fluorescein angiography. The group that received combined treatment had better outcome in terms of reduction of macular thickness. There was no statistically significant intraocular pressure elevation among the three treatment groups or within each group of patients. A positive trend regarding visual improvement was observed in the group receiving combined treatment in spite of the lowest initial visual acuity, highest value of macular thickness and longest mean duration of symptoms. In conclusion, combined treatment with bevacizumab and triamcinolone for the treatment of retinal vein occlusion is more potent, safe, efficient and cost-effective. It can also be recommended because fewer injections are needed in patients undergoing treatment for macular edema.

Improvement of endothelial function by pitavastatin: a meta-analysis.

OBJECTIVE: Dyslipidemia is commonly associated with endothelial dysfunction and increased cardiovascular risk. Pitavastatin has been shown to reduce total and low-density lipoprotein cholesterol, to increase high-density lipoprotein (HDL)-cholesterol and improve HDL function. Furthermore, several trials explored its effects on flow-mediated dilation (FMD), as an index of endothelial function. The authors evaluated the effect of pitavastatin therapy on FMD. METHODS: The authors performed a systematic review and meta-analysis of all clinical trials exploring the impact of pitavastatin on FMD. The search included PubMed-Medline, Scopus, ISI Web of Knowledge and Google Scholar databases. Quantitative data synthesis was performed using a random-effects model, with weighted mean difference (WMD) and 95% confidence interval (CI) as summary statistics. RESULTS: Six eligible studies comprising 7 treatment arms were selected for this meta-analysis. Overall, WMD was significant for the effect of pitavastatin on FMD (2.45%, 95% CI: 1.31, 3.60, p < 0.001) and the effect size was robust in the leave-one-out sensitivity analysis. CONCLUSION: This meta-analysis of all available clinical trials revealed a significant increase of FMD induced by pitavastatin.

Effects of statin therapy on augmentation index as a measure of arterial stiffness: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the effects of statin therapy on augmentation index (AIx) as a measure of arterial stiffness using a meta-analysis of clinical trials. METHODS: The search included PubMed-Medline, Embase, SCOPUS, Web of Science and Google Scholar databases to identify randomized controlled trials investigating the effects of statin therapy on arterial stiffness measured as AIx. A random-effects model and generic inverse variance method were used for quantitative data synthesis. Sensitivity analysis was conducted using the leave-one-out method. Random-effects meta-regression was performed using unrestricted maximum likelihood method to evaluate the impact of potential confounders. RESULTS: 18 trials examining the effects of statin therapy on arterial stiffness were included. A significant reduction in aortic AIx following statin therapy was proven (WMD: -2.40%, 95% CI: -4.59, -0.21, p=0.032; I(2): 51.20%). HR-adjusted AIx 75% values also revealed a significant improvement by statin therapy (WMD: -5.04%, 95% CI: -7.81, -2.27, p<0.001; I(2): 0%), but not when analysis was restricted to unadjusted AIx values (WMD: -2.30%, 95% CI: -4.83, 0.23, p=0.075; I(2): 53.83%). There was no significant change in carotid (WMD: -2.75%, 95% CI: -8.06, 2.56, p=0.309; I(2): 26.86%) and peripheral (WMD: 0.25%, 95% CI: -3.31, 3.82, p=0.889; I(2): 72.19%) AIx due to statin treatment. There was also no difference in the effect size calculated for different statins subgroups. The impact of statins on AIx was independent of LDL-cholesterol level (slope: 0.05; 95% CI: -0.02, 0.13; p=0.181). CONCLUSION: Statin therapy causes a significant reduction in aortic AIx which is independent of LDL-cholesterol changes.

Unruptured Giant Intracranial Aneurysm of the Internal Carotid Artery: Late Ocular Symptoms.

An unruptured giant intracranial aneurysm of the internal carotid artery may tend to present with late ocular symptoms. This is the case of a 58-year-old female patient with a giant unruptured aneurysm of the right internal carotid artery. The patient presented with exclusively progressive reduction of visual acuity and visual field defects due to the mass effect of the growing aneurysm. The rupture of the aneurysm occurred before planned treatment. Clinical suspicion and timely recognition as well as prompt treatment play an important role in the final outcome of the management of giant unruptured intracerebral aneurysms.

Association between plasma triglycerides and high-density lipoprotein cholesterol and microvascular kidney disease and retinopathy in type 2 diabetes mellitus: a global case-control study in 13 countries.

BACKGROUND: Microvascular renal and retinal diseases are common major complications of type 2 diabetes mellitus. The relation between plasma lipids and microvascular disease is not well established. METHODS AND RESULTS: The case subjects were 2535 patients with type 2 diabetes mellitus with an average duration of 14 years, 1891 of whom had kidney disease and 1218 with retinopathy. The case subjects were matched for diabetes mellitus duration, age, sex, and low-density lipoprotein cholesterol to 3683 control subjects with type 2 diabetes mellitus who did not have kidney disease or retinopathy. The study was conducted in 24 sites in 13 countries. The primary analysis included kidney disease and retinopathy cases. Matched analysis was performed by use of site-specific conditional logistic regression in multivariable models that adjusted for hemoglobin A1c, hypertension, and statin treatment. Mean low-density lipoprotein cholesterol concentration was 2.3 mmol/L. The microvascular disease odds ratio increased by a factor of 1.16 (95% confidence interval, 1.11-1.22) for every 0.5 mmol/L (≈1 quintile) increase in triglycerides or decreased by a factor of 0.92 (0.88-0.96) for every 0.2 mmol/L (≈1 quintile) increase in high-density lipoprotein cholesterol. For kidney disease, the odds ratio increased by 1.23 (1.16-1.31) with triglycerides and decreased by 0.86 (0.82-0.91) with high-density lipoprotein cholesterol. Retinopathy was associated with triglycerides and high-density lipoprotein cholesterol in matched analysis but not significantly after additional adjustment. CONCLUSIONS: Diabetic kidney disease is associated worldwide with higher levels of plasma triglycerides and lower levels of high-density lipoprotein cholesterol among patients with good control of low-density lipoprotein cholesterol. Retinopathy was less robustly associated with these lipids. These results strengthen the rationale for studying dyslipidemia treatment to prevent diabetic microvascular disease.

Risk factors for microvascular atherosclerotic changes in patients with type 2 diabetes mellitus.

Diabetes mellitus is a metabolic disorder primarily characterized by elevated blood glucose levels and by microvascular and macrovascular complications which increase the morbidity and mortality. The aim of this study was to assess whether in high risk patients with type 2 diabetes mellitus whose blood pressure and lipid levels are well controlled still exist risk factors for microvascular changes and target organ damage (nephropathy and retinopathy). In this case control retrospective study 326 patients (111 with nephropathy and/or retinopathy and 215 controls) were enrolled. Nephropathy or retinopathy was present in 10.1% and 26.9% cases, respectively. Only 71% of patients (no significant difference between cases and controls) were treated with antidiabetic drugs. Therefore their diabetes was not properly controlled (hemoglobin A1c was 7.96% in cases and 7.58% in controls). Patients with microvascular changes had significantly longer diabetes than the controls (p < 0.05) but there were no significant differences between these two groups concerning lipids concentrations. Statins and fibrates were used by significantly less (p < 0.05) patients with microvascular complications than by those without them (21.6% vs. 36.3% and 1.8% vs. 17.2% respectively). The results of this study suggest that the duration of the disease and adequate control of glycaemia in patients with type 2 diabetes mellitus are more important for microvascular complications than the serum lipoproteins levels. Lipid-lowering treatment might have an impact on microvascular complications in patients with type 2 diabetes, irrespectively of their serum lipid levels.

Prevalence and types of persistent dyslipidemia in patients treated with statins.

AIM: To determine the prevalence and types of persistent dyslipidemia in patients treated with different statins to reduce cardiovascular disease (CVD) risk, as well as to determine the proportion of high risk patients who did not reach the lipid target values and assess cardiologists' further treatment advice for these patients. METHODS: This cross-sectional, observational study recruited 1849 outpatients from all parts of Croatia between January and September 2011 (44.6% women), 19 to 90 years old (average age 63.13) treated with statins for at least 6 months. We analyzed how the potency and type of lipid-lowering treatment were correlated with CVD risk level and achieving treatment goals according to 2007 Joint European Guidelines on CVD prevention. RESULTS: Most patients (81.3%) were at high risk for CVD. The most frequently used statin was atorvastatin (42.8%), followed by simvastatin (27.6%) and rosuvastatin (22.8%). Only 35.5% patients achieved low density lipoprotein-cholesterol treatment target. Patients treated with more potent statins had better results. A total of 22.3% of patients had high density lipoprotein-cholesterol below 1.0 mmol/L (~40 mg/dL) for men and below 1.2 (~45 mg/dL) for women and 46.4% had triglycerides above 1.7 mmol/L (~150 mg/dL) but there were no significant differences between statins in improving these parameters. Most of the patients on more potent statins were not advised by their cardiologists to change the type or dosage of statin, which was more common in patients on less potent statins. CONCLUSION: A considerable number of patients treated with statins did not achieve the treatment goal values. The results were better in patients treated with more potent statins and cardiologists advised them much less frequently to change the type and dosage of statin. There is a need for more intensive treatment, especially for high-risk patients. This could be accomplished by optimizing patients' adherence, using more potent statins, titrating current statin therapy to higher doses, or using a combined lipid-lowering treatment.

[Is hypertriglyceridaemia a risk factor for coronary heart disease?]. / Je li hipertrigliceridemija cimbenik rizika od koronarne bolesti srca?

Although it is still not clear whether elevated serum triglycerides are directly atherogenic or not, the results of many studies indicate that they are undoubtedly an important risk factor/biomarker for coronary heart disease (CHD). Therefore, targeting hypertriglyceridaemia should be beneficial for subjects at high risk for CHD. Elevated triglycerides are often accompanied with low HDL cholesterol, particularly in high risk patients with diabetes type 2 and/or metabolic syndrome. Such a disturbance is called atherogenic dyslipidaemia and has an increasing prevalence. The treatment of hypertriglyceridaemia has to be focused primarily on intensive lifestyle changes (weight reduction in obesity, reduction of alcohol consumption as well as reduction of added sugars, fructose and trans-fatty acids, regular aerobic physical activity) by which reduction of up to 50% in triglycerides can be achieved. Subjects with high CHD risk who cannot lower hypertriglyceridaemia by lifestyle measures should be treated with pharmacological therapy. The available medications include fibrates, niacin and prescription omega-3 polyunsaturated fatty acids. If LDL cholesterol is elevated too, combination therapy is needed. Based upon recent studies in such patients a combination of a statin with fenofibrate and/or omega-3 fatty acids can be recommended.

The perception and knowledge of cardiovascular risk factors among medical students.

AIM: To assess perceptions, knowledge, and awareness of cardiovascular disease (CVD) risk factors among medical students (freshmen and graduating students). METHODS: A descriptive cross-sectional survey based on an anonymous self-administered questionnaire was conducted in 2008 on 443 medical students - 228 freshmen on their enrollment day and 214 students on the day of their final exam at the University of Zagreb School of Medicine, Croatia. RESULTS: The perception and knowledge of some CVD risk factors, eg, dyslipidemia, arterial hypertension, and metabolic syndrome as well as of lipid-lowering therapy important for CVD prevention was significantly better among graduating students but was still not sufficient. Only 66% of graduating students reported that they would prescribe lipid-lowering therapy to high risk patients. Disappointingly, many graduating students were smoking (30.4%) and had low-awareness of obesity as an important CVD risk factor. CONCLUSION: These results suggest an urgent need to improve medical students' knowledge of obesity and low physical activity as important CVD risk factors and of the methods for increasing low high-density lipoprotein-cholesterol and for smoking cessation. All this provides a rationale for modifying the university core curriculum to include more information concerning these issues.

[Low HDL-cholesterol--an important risk factor for cardiovascular diseases]. / Snizeni HDL-kolesterol--vazan cimbenik rizika od kardiovaskularnih bolesti.

It has been known for quite a long time that the concentration of HDL-cholesterol correlates inversely with cardiovascular disease (CVD) risk and that low HDL-cholesterol is an independent CVD risk factor. This review aims to highlight evidence on several topics concerning the role of HDL particles and the importance of HDL-cholesterol. The main antiatherogenic functions of HDL particles are presented in details--reverse cholesterol transport, but also their anti-oxidant, anti-inflammatory, anti-thrombotic and anti-apoptotic properties as well as endothelial stabilizing and repair properties. Lifestyle management of low HDL-cholesterol is explained, particularly physical activity and aerobic exercise, smoking cessation, weight reduction in the overweight individuals and composition of the diet but also moderate alcohol consumption stressing the fact that HDL particles from alcoholics are dysfunctional. This is important since it has been shown that it is not only the quantity of HDL particles, and thus HDL-cholesterol level in plasma, that matters, but their quality and impaired functionality as well. HDL from diabetic subjects also lose some of their antiatherogenic properties but a common feature of patients with diabetes type 2 is atherogenic dyslipidemia which is characterized exactly by low HDL-cholesterol and high triglycerides. Diabetic patients with such dyslipidemia are at particularly high CVD risk and the results of recent studies such as ACCORD-Lipid suggest that in them treatment of these lipid abnormalities may be beneficial. Treatment options with fibrates, particularly fenofibrate, and niacin are discussed based upon published trials, as well as combination therapy with these medicines and other lipid-lowering drugs.

Public perceptions of cardiovascular risk factors in Croatia: the PERCRO survey.

OBJECTIVE: Since there are almost no data about the perceptions and attitudes of the general public concerning risk factors for cardiovascular diseases (CVD) this survey was performed. METHOD: Face-to-face interviews were conducted based upon a questionnaire with 883 members of the general population from different parts of Croatia in October-November 2008. RESULTS: 36.1% of them correctly identified CVD as the leading cause of death but the most feared disease was cancer (40.0%). CVD was on the second place with only 21.6%. 30.9% was aware that elevated LDL-cholesterol increases CVD risk but 49.0% knew that high HDL-cholesterol is beneficial. 43.3% knew their total cholesterol (TC) value and 74.4% knew their blood pressure (BP). 30.9% knew what their target TC should be and 33.9% knew what their target BP should be. The knowledge about TC and BP target values was positively associated with higher educational level. 53.2% of the general public reported that they have never discussed any CVD risk factor with their physician. CONCLUSION: These data suggest insufficient awareness of CVD risk factors in general population and a need for improved promotion of CVD prevention. To achieve this people and physicians should be motivated by the health authorities and/or insurance companies.

Physicians' perception, knowledge and awareness of cardiovascular risk factors and adherence to prevention guidelines: the PERCRO-DOC survey.

BACKGROUND: Cardiovascular diseases (CVD) are the major cause of premature death in the world. This study was designed to examine the physicians' knowledge and perception of CVD risk factors and perceived implementation of CVD prevention guidelines as well as barriers to their implementation. METHODS: A questionnaire survey by face-to-face interviews was performed among 1382 randomly selected physicians (general practitioners/family medicine specialists, internists and cardiologists) from different regions of Croatia. RESULTS: Most physicians believe that guidelines are useful but only 56.9% are really using some guidelines. 40.2% favour Joint European guidelines. More primary care physicians use their own personal experience in prevention while internists and cardiologists tend more to use the guidelines. 80.6% believe that they treat their patients with dyslipidemia well but only 53.3% knew the LDL-cholesterol goal value for high-risk patients and only 56.2% knew which HDL-cholesterol level is the marker of increased risk. Hypertension was perceived as the most important risk factor, particularly by primary care physicians, while cardiologists tend to favour diabetes. Although most physicians considered the lack of financial resources as the main barrier in CVD prevention, at the same time most of them believe that it could primarily be improved by better patient education. CONCLUSIONS: Although most physicians support the guidelines use, only half of them use them and in average their knowledge of guidelines is not satisfactory. This is, together with the lack of time and finances and perceived lack of patients' awareness, probably one of the main causes why they do not manage risk factors better.

Intralesional triamcinolone acetonide injection for chalazion.

The aim of the study was to evaluate the efficacy of intralesional triamcinolone acetonide injection in primary and recurrent chalazion. The study included 30 patients with primary and recurrent chalazion (37 cases) and 24 patients as a control group. Patients with primary and recurrent chalazion received intralesional injection of 0.1 to 0.2 mL triamcinolone acetonide (40 mg/mL). Control group received intralesional injection of 0.1 to 0.2 mL 0.9% NaCl. Data on the lesion size, including digital color photography, lesion regression or recurrence, and complete ophthalmic examination were recorded at the time of injection and after a week or two until resolution or surgical excision. Success was defined as at least 80% decrease in size with no recurrence. Resolution of the lesion was found in 35 cases after one or two injections, with a mean time to resolution of 15.27 +/- 6.12 days. Subcutaneous injection of the steroid triamcinolone acetonide in primary and recurrent chalazion appears to be a simple and efficacious therapeutic option for chalazion.

Endogenous steroid sex hormones and atherosclerosis of retinal arteries in men.

BACKGROUND: Increasing evidence suggests that both male and female sex hormones may be associated with the development of atherosclerosis, but almost all such data are based on studies of patients with coronary artery disease. To our knowledge, there are no data on the effects of endogenous sex hormones on atherosclerosis of the retinal arteries in men, and the purpose of this study was to explore that association. MATERIAL/METHODS: In 101 consecutive adult male patients treated in a university hospital outpatient clinic, atherosclerotic changes of the retinal vessels were identified prospectively by direct ophthalmoscopy and were graded on a scale of 1 to 4 according to Scheie. Commercial radioimmunoassay kits were used to measure serum levels of testosterone, estradiol, progesterone, androstenedione, and dehydroepiandrosterone sulfate. The chi-square test was used to compare the results with those from 47 matched male subjects with healthy retinal vessels. RESULTS: Retinal vessel atherosclerosis was inversely correlated with the serum progesterone concentration (P<0.001). The lower the progesterone concentration, the more advanced the stage of retinal vessel disease. A similar but less statistically significant correlation was noticed for dehydroepiandrosterone sulfate (P<0.05). A weak (P<0.05) similar association between the degree of retinal artery atherosclerosis and estradiol levels was also found. CONCLUSIONS: Low endogenous progesterone levels and, to a degree, low dehydroepiandrosterone sulfate and estradiol levels might be associated with atherosclerosis of the retinal arteries in men.

[The effects of plant sterols on hypercholesterolemia]. / Ucinci biljnih sterola na hiperkolesterolemiju.

Increased serum total and LDL-cholesterol concentrations are major risk factors for cardiovascular diseases. Many clinical trials have proven that plant sterol and stanol esters can effectively decrease high serum total and LDL cholesterol. They reduce the intestinal absorption of cholesterol by decreasing the incorporation of dietary and biliary cholesterol into micelles displacing cholesterol from these micelles. They also increase LDL receptor activity on liver cells causing a higher uptake of LDL cholesterol and thus decreasing the serum LDL cholesterol concentration. Animal studies have indicated that plant sterols and stanols may also lower atherosclerotic lesions development. However, the evidence from human studies to confirm this is still lacking. Anyhow, plant sterol and stanol esters can be considered as an effective and safe cholesterol-lowering functional food ingredient. To achieve additional effects they can be combined with statin therapy, and this combination is also well tolerated and safe.

[The role of omega-3 fatty acids from fish in prevention of cardiovascular diseases]. / Uloga omega-3 masnih kiselina iz riba u prevenciji kardiovaskularnih bolesti.

Fish and fish oil are rich sources of omega-3 fatty acids--essential polyunsaturated fatty acids. These acids in doses of 1 g per day have been shown to significantly reduce the all-cause mortality in post myocardial infarction (MI) patients and the risk for sudden death caused by cardiac arrhythmias. One of the recently most studied mechanisms that may contribute to this benefits of omega-3 fatty acids is their anti-arrhythmic effect. Namely, these acids influence membrane ion channels, increase ventricular fibrillation threshold and increase heart rate variability. Although the data concerning primary prevention is less straightforward than the data relating secondary prevention, it seems that the use of omega-3 fatty acids in primary prevention might be justified as well. In higher doses (2 to 4 g per day) they are used to treat hypertriglyceridemia. Potential mechanisms by which omega-3 fatty acids may reduce risk for cardiovascular disease include also antithrombotic (they decrease platelet aggregation/reactivity, reduce plasma viscosity, enhance fibrinolysis) and anti-inflammatory effects (e.g. they decrease IL-6, MCP-1, TNF), improving vascular endothelial cell function (e.g. they increase availability of nitric oxide), reducing expression of endothelial cells adhesion molecules, inhibiting smooth muscle cells migration and proliferation, and reducing blood pressure. Based upon clinical studies the use of omega-3 fatty acids should be considered today at least as a part of comprehensive secondary prevention strategy in post-MI patients. It has been also shown that adding highly concentrated omega-3 fatty acids to standard treatment in the secondary prevention of MI is cost effective versus standard treatment alone. Particularly important is that there are no significant drug interactions with omega-3 fatty acids.

Rice policosanol does not have any effects on blood coagulation factors in hypercholesterolemic patients.

Policosanol is an agent that includes mixtures of aliphatic primary alcohols extracted primarily from sugercane wax. Policosanol has been shown to lower total and LDL cholesterol in animal models, healthy volunteers and hypercholesterolemic patients. However, these findings have been challanged recently. Up to now, there has been no study investigating the effects ofpolicosanol on blood coagulation factors. This study investigated the effects of rice policosanol (Oryza sp.) 10 mg/day on blood coagulation factors in 66 hypercholesterolemic patients of both sexes aged 20 to 78 years in a single center, randomized, double-blind, placebo-controlled, crossover trial. After an 8-week run-in period in which patients were placed on therapeutic lifestyle changes, in particular a cholesterol-lowering diet, they were randomly assigned to receive rice policosanol 10 mg tablets or placebo tablets once daily with the evening meal for 8 weeks. During next 8 weeks those receiving policosanol during the first 8 weeks, received placebo and those taking placebo during the first 8 weeks, received policosanol. Plasma fibrinogen, factors VII, VIII, XII and XIII were measured before and after the treatment. Rice policosanol treatment did not change significantly neither fibrinogen nor factors VII, VIII, XII and XIII.

Analysis of the qualitative dermatoglyphics of the digito-palmar complex in patients with primary open angle glaucoma.

The primary open-angle glaucomas are a group of diseases that have in common characteristic morphological changes at the optic nerve head and retinal nerve fiber layer, progressive retinal ganglion cells death and characteristic visual field loss. The risk for primary open angle glaucoma rises continuously with the level of the intraocular pressure. The disease advances slowly and there are no symptoms. Primary open angle glaucoma is caused by abnormal aqueous humour outflow in the trabecular meshwork in the open angle. Etiopathogenesis of primary open angle glaucoma is unclear. The increased risk of glaucoma in relatives has long been recognized. Frequency for manifestation of the disease is 10-30% in family members. The discovery of the specific gene loci responsible for the manifestation of glaucoma has helped us to understand its mechanism of origin and definitely confirmed the hereditary nature of this disease. Digito-palmar dermatoglyphs were already used to determine hereditary base of many diseases and it was the reason for investigation of their qualitative patterns in patients with glaucoma (22 males and 23 females), their immediate relatives (19 males and 23 females) in comparison to a group of phenotypically healthy population (52 males and 56 females). The results pointed a connection with the dermatoglyphic traits of the digito-palmar complex between patients with glaucoma and their immediate relatives. There is a possible discrimination of patients and their immediate relatives from phenotypically healthy population, too.