High interindividual variability in LDL-cholesterol reductions after inclisiran administration in a real-world multicenter setting in Germany.

BACKGROUND AND AIMS: Low-density lipoprotein cholesterol (LDL-C) is the main therapeutic target in the treatment of hypercholesterolemia. Small interfering RNA (siRNA) inclisiran is a new drug, which targets PCSK9 mRNA in the liver, reducing concentrations of circulating LDL-C. In randomized trials, inclisiran demonstrated a substantial reduction in LDL-C. The German Inclisiran Network (GIN) aims to evaluate LDL-C reductions in a real-world cohort of patients treated with inclisiran in Germany. METHODS: Patients who received inclisiran in 14 lipid clinics in Germany for elevated LDL-C levels between February 2021 and July 2022 were included in this analysis. We described baseline characteristics, individual LDL-C changes (%) and side effects in 153 patients 3 months (n = 153) and 9 months (n = 79) after inclisiran administration. RESULTS: Since all patients were referred to specialized lipid clinics, only one-third were on statin therapy due to statin intolerance. The median LDL-C reduction was 35.5% at 3 months and 26.5% at 9 months. In patients previously treated with PCSK9 antibody (PCSK9-mAb), LDL-C reductions were less effective than in PCSK9-mAb-naïve patients (23.6% vs. 41.1% at 3 months). Concomitant statin treatment was associated with more effective LDL-C lowering. There was a high interindividual variability in LDL-C changes from baseline. Altogether, inclisiran was well-tolerated, and side effects were rare (5.9%). CONCLUSION: In this real-world patient population referred to German lipid clinics for elevated LDL-C levels, inclisiran demonstrated a high interindividual variability in LDL-C reductions. Further research is warranted to elucidate reasons for the interindividual variability in drug efficacy.

Unveiling the power of convolutional neural networks in melanoma diagnosis.

Convolutional neural networks are a type of deep learning algorithm. They are mostly applied in visual recognition and can be used for the identification of melanomas. Multiple studies have evaluated the performance of convolutional neural networks, and most algorithms match or even surpass the accuracy of dermatologists. However, only 23.8% of dermatologists have good or excellent knowledge of the topic. We believe that the lack of knowledge physicians experience regarding artificial intelligence is an obstacle to its clinical implementation. We describe how a convolutional neural network differentiates a benign from a malignant lesion. We systematically searched the Web of Science, Medline (PubMed), and The Cochrane Library on the 9th February, 2022. We focused on articles describing the role and use of artificial intelligence in melanoma recognition between 2017 and 2022, using the following MeSH terms: "melanoma," "diagnosis," and "artificial intelligence". Traditional machine learning algorithms comprise different parts which must preprocess, segment, extract features and classify the lesion into benign or malignant. Deep learning algorithms can perform these steps simultaneously, which significantly enhances efficiency. Convolutional neural networks include a convolutional layer, a pooling layer, and a fully connected layer. Convolutional and pooling layers extract features from the lesion and reduce computational power, whereas fully connected layers classify the image into two or more categories. Additionally, we suggest that further studies should be performed to accelerate the clinical implementation of artificial intelligence, to create comprehensive datasets and to generate explainable algorithms.

Two Consecutive Invasive Surgeries Utilizing Zymogen Protein C (ZPC) That Enhanced Patient Safety and Reduced Costs.

This case report describes a major surgical procedure for a protein C-deficient, hypercoagulable patient who underwent two back-to-back invasive surgeries, hip replacement, and spinal stenosis correction. The patient, an 84-year-old male with a history of deep vein thromboses (DVT) and pulmonary emboli (PE), was treated pre-, peri-, and postoperatively with zymogen protein C (ZPC-Baxter, International) and recovered without clotting or increased bleeding. During the procedure, the patient was not administered any other anticoagulants. There have now been several case reports on different patients with unrelated teams in various locations worldwide using zymogen protein C during surgical procedures. Thus, this procedure is becoming a viable choice for patients with a high probability of clotting during and after invasive surgery. This case focuses on accomplishing safer surgery and reducing costs, by using less ZPC while accomplishing two surgeries in one procedure. As a result, this procedure might be useful for many medical situations where acquired protein C deficiency could be a problem (e.g., sepsis, pregnancy, etc.). This approach may have greater application to medical conditions other than protein C deficiency, where clotting and inflammation can become issues.

[Lipid profile and cardiovascular risk of participants in the lipid measurement program in the industrial park in Höchst]. / Lipidprofil und kardiovaskuläres Risiko der Teilnehmer an den Lipidmesstagen im Industriepark Höchst.

BACKGROUND: Cardiovascular (CV) diseases are still the most frequent cause of death in industrial nations. Employer-initiated screening of the CV risk could make an early contribution to optimization of the prevention strategies. METHODS: In a cross-sectional study the CV risk profile (e.g., dyslipidemia, hypertension, smoking, diabetes mellitus and familial disposition) of 1436 employees at the industrial park in Frankfurt Höchst was analyzed. The total risk was estimated using the PROCAM score. RESULTS: A hypercholesterolemia (low-density lipoprotein, LDL >130 mg/dl) was detected in 36% of the participants. Of the high-risk participants (myocardial infarct, apoplexy and/or diabetes) 23.7% (n = 9/38) were in the target range for LDL as defined by the European Society of Cardiology (ESC) of below 70 mg/dl, 18.4% (n = 7) had levels between 70 and 100 mg/dl and 57.9% (n = 22) had levels of more than 100 mg/dl. In addition, more than half of the subjects (53.2%) had increased blood pressure values (defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg). The prevalence of diabetes (blood sugar >126 mg/dl) was very low (1.3%) as was the frequency of manifest CV diseases (1.4% myocardial infarct or apoplexy, 2.9% stabile angina pectoris or peripheral arterial occlusive disease, PAOD). CONCLUSION: The data confirm that the risk factors high blood pressure and dyslipidemia are widespread and the achievement of target values is insufficient, particularly with a high risk of CV. Behavioral therapeutic and/or pharmaceutical measures should be instigated in order to better exploit the high preventive potential for carriers of these risk factors.

Frailty and the Metabolic Syndrome - Results of the Berlin Aging Study II (BASE-II).

BACKGROUND: Frailty and the metabolic Syndrome (MetS) are frequently found in old subjects and have been associated with increased risk of functional decline and dependency. Moreover, central characteristics of the MetS like inflammation, obesity and insulin resistance have been associated with the frailty syndrome. However, the relationship between MetS and frailty has not yet been studied in detail. Aim of the current analysis within the Berlin Aging Study II (BASE-II) was to explore associations between MetS and frailty taking important co-variables such as nutrition (total energy intake, dietary vitamin D intake), physical activity and vitamin D-status into account. METHODS: Complete cross-sectional data of 1,486 old participants (50.2% women, 68.7 (65.8-71.3) years) of BASE-II were analyzed. MetS was defined following the joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity in 2009. Frailty was defined according to the Fried criteria. Limitations in physical performance were assessed via questionnaire, muscle mass was measured using dual energy X-ray absorptiometry (DXA) and grip strength using a Smedley dynamometer. Adjusted regression models were calculated to assess the association between MetS and Frailty. RESULTS: MetS was prevalent in 37.6% of the study population and 31.9% were frail or prefrail according to the here calculated frailty index. In adjusted models the odds of being frail/prefrail were increased about 50% with presence of the MetS (OR1.5; 95% CI 1.2,1.9; p= 0.002). Moreover the odds of being prefrail/frail were significantly increased with low HDL-C (OR: 1.5 (95%CI: 1.0-2.3); p = 0.037); and elevated waist circumference (OR: 1.65 (95%CI: 1.1-2.3); p = 0.008). CONCLUSION: The current analysis supports an association between MetS and frailty. There are various metabolic, immune and endocrine alterations in MetS that also play a role in mechanisms underlying the frailty syndrome. To what extent cytokine alterations, inflammatory processes, vitamin D supply and hormonal changes in age and in special metabolic states as MetS influence the development of frailty should be subject of further research.

Effect of different lipid apheresis methods on plasma polyunsaturated fatty acids.

Lipoprotein apheresis has been shown to improve the cardiovascular outcome in patients with atherosclerotic disease and therapy-refractory hypercholesterolemia or elevated lipoprotein (a) (Lp(a)). An elevated intake of omega-3 polyunsaturated fatty acids such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) has also been associated with a reduced cardiovascular risk. However, until now only little is known about the effect of apheresis treatment on the levels of omega-6 and omega-3 polyunsaturated fatty acids (n-6 PUFA and n-3 PUFA) in patients. Using gas chromatography (GC) the present study analyzed the content of n-6 and n-3 PUFA as well as saturated fatty acids and monounsaturated fatty acids in the plasma of 20 patients with hyperlipidemia undergoing regular lipoprotein apheresis procedures in direct pre- and post-therapy measurements. Lipoprotein apheresis uniformly reduced the concentrations of arachidonic acid (AA), EPA and DHA fatty acids analyzed in the plasma. However, the three different apheresis methods analyzed (heparin precipitation, membrane filtration and direct absorption) had different effects on the fatty acid profile in the plasma. We found that heparin precipitation and direct absorption apheresis procedures led to a significant decrease of plasma n-3 and n-6 PUFA by 40-50%. In contrast, patients undergoing membrane filtration apheresis, levels pre- and post-apheresis did not change significantly, with AA and EPA being only reduced by approximately 10% while levels of DHA were maintained pre- and post-apheresis. In contrast, total triglyceride levels were lowered most potently by membrane filtration apheresis. In summary, heparin precipitation and direct absorption apheresis approaches significantly lowered polyunsaturated fatty acids in plasma, while membrane filtration did not. This might have implications for cardiovascular and inflammatory risk/benefit profiles associated with n-6 and n-3 PUFA levels in the body.

[Severe hypertriglyceridemia : Diagnostics and new treatment principles]. / Schwere Hypertriglyzeridämie : Diagnostik und neue Therapieprinzipien.

Severe hypertriglyceridemia is defined at a plasma triglyceride (TG) concentration of >885 mg/dl and may result - in particular when clinical symptoms appear before the age of 40 - from "large variant" mutations in genes which influence the function of the lipoprotein lipase (LPL). For diagnosis, secondary factors have to be excluded and treated before further genetic tests are considered. Typical symptoms in almost all patients are recurrent, sometimes severe abdominal pain attacks, which can result in acute pancreatitis, the most important, sometimes life-threatening complication. To minimize the risk of severe pancreatitis, the aim is to maintain the plasma TG concentration <1000 mg/dl. Other clinical manifestations which can occur and are reversible are eruptive xanthomas, lipemia retinalis, hepatosplenomegaly, dyspnea syndrome, and impaired neurocognitive function. The hyperviscosity syndrome caused by chylomicronemia is seen as the underlying reason for some of the symptoms. Patients with mild-to-moderate hypertriglyceridemia have an increased cardiovascular risk. To lower this is the primary treatment goal here. Treatment mainly consists of a life-long, strict fat- and carbohydrate-restricted diet and the abstention from alcohol. Omega­3-Fatty acids and fibrates can be used to lower plasma TG levels. Recently, new gene therapy approaches for LPL-deficient patients have become available in Germany.

[App-based self-monitoring in type 2 diabetes]. / App-basiertes Selbstmonitoring bei Typ-2-Diabetes.

BACKGROUND: The success of self-monitoring in the treatment of type 2 diabetes mellitus has already been verified in several studies. To date there are a multitude of smartphone apps which support diabetic patients in systematically recording and analyzing relevant health data; however, most of these smartphone apps are primarily developed for a young target group. OBJECTIVE: As part of this study we examined to what extent a smartphone app for self-monitoring is used by older diabetic patients. METHODS: In this study 36 adults with type 2 diabetes mellitus older than 60 years were included. After a comprehensive training course the participants used the application for 3 months. Reminders for medication, physical activity and diet could be set and recorded health data, such as weight or blood sugar, could be entered into the app. After 3 months the data were analyzed concerning usage behavior and impact on overall health. RESULTS: Data analysis revealed intensive usage of the smartphone app (90 % on a daily basis). Furthermore, according to the patients, after the study period significant improvements in medication adherence and psychological well-being were recorded [t[35] = -2.24, p < 0.05). Additional motivational elements did not influence the usage behavior by older adults. CONCLUSION: Until now only a small proportion of older adults used smartphone health apps, despite the ubiquitous availability. These apps have to be tailored to the requirements of older adults so that the market will be opened up to them. Using self-monitoring apps can help older adults to structure their daily routine despite their disease.

Prevalence of skin diseases in hospitalized geriatric patients : Association with gender, duration of hospitalization and geriatric assessment.

BACKGROUND: Improvement of quality of life in old age and prevention of age-associated diseases have become the main focus of research into aging; however, information regarding the skin health status of geriatric patients still remains sparse. GOAL: To investigate the extent of dermatological diseases in hospitalized geriatric patients, map the most prevalent ones, check for any gender differences and document any correlations with duration of hospitalization and results of geriatric assessments. PATIENTS AND METHODS: A total of 110 hospitalized geriatric patients underwent a complete dermatological examination at the Evangelical Geriatric Hospital (Evangelisches Geriatriezentrum) Berlin. The collected information was stratified according to dermatological diagnosis, results of geriatric assessments, duration of hospitalization, age and gender of the patients. RESULTS: The average number of diagnosed skin diseases per patient was 3.7 ± 1.8 for the female population and 4.3 ± 2.0 for the male population. After categorizing all diagnosed skin diseases, infectious diseases were found to be most common in both female and male patients (55 % and 58 %, respectively) followed by vascular diseases (46.7 % and 54 %, respectively). Precancerous skin lesions and epithelial skin cancer were more frequent in men than in women (20 % vs. 6.7 %, p < 0.037 and 34 % vs. 13.3 %, p < 0.010, respectively). Pruritus showed a positive correlation with the duration of hospitalization and a negative correlation with the Barthel index and Tinetti score on the day of discharge, indicating that pruritus may have a significant impact on the physical condition of elderly multimorbid patients and on the static and dynamic balance abilities. CONCLUSION: Our results demonstrate that skin health in the elderly is compromised and disregarded and this should constitute one of the top priorities of healthcare specialists and physicians in the future.

ISOTT from the Beginning: A Tribute to Our Deceased Members (Icons).

ISOTT was founded by Drs. Duane F. Bruley and Haim I. Bicher in the state of South Carolina, USA in 1973. The symposium was jointly held at Clemson University (Clemson, SC, USA) and the Medical College of South Carolina (Charleston, SC, USA), which are geographically located 260 miles apart. This venue resulted from Dr. Bruley's (Clemson University) wish to have a meeting on Oxygen Transport to Tissue and with it to honor the research collaboration between the two universities and Dr. Melvin H. Knisely's accomplishments on studies regarding "blood sludging" in the microcirculation. Because of the unexpected large response to the symposium, Drs. Bruley and Bicher decided to found an international society at this meeting (ISOTT). The purpose of this paper is to summarize the formalization of ISOTT and to honor important contributors to the society who have since passed away. The authors did their best to include a brief overview of our past icons who have excelled in leadership as well as science/engineering, and apologize if someone has been mistakenly left out or if data is inaccurate or incomplete.

A Compelling Case for the Use of Perioperative Zymogen Protein C for Increased Patient Safety.

It is imperative to maintain normal blood flow to provide adequate oxygen supply to specific organs and cells, as well as for the removal of metabolic byproducts. Therefore, any situation that results in blood clotting can injure or kill living tissues. In this paper, we describe a case where a protein C deficient subject who would, by all medical indicators, be at 100 % risk of experiencing thrombophlebitis, deep vein thrombosis, and or lung emboli, is able to escape all pathologies by using perioperative zymogen protein C (ZPC). This protein C deficient patient has a long history of blood clotting, particularly from surgical procedures. The patient is 81 years old and first experienced clotting due to hernia surgery in 1964, when he was hospitalized for 16 days post-surgery with life threatening complications. It was later determined in 1980, after many episodes, that the patient had hereditary protein C deficiency at the 38 % level. In his hernia surgery, perioperative ZPC was used along with accepted anticoagulation procedures with no blood clots or other related side effects occurring. This procedure can greatly benefit protein C deficient patients, and could potentially find use for non-PC deficient patients in surgeries and a variety of other medical treatments. This particular case helps to validate the importance of ZPC in effecting safer surgery in high-risk patients. It also supports the mechanism of ZPC acting as an anticoagulant without causing bleeding. Most importantly, each clinical case study represents a unique combination of surgeon, hematologist, medical staff, and patient functioning as a coordinated team. In this case, smaller amounts of very expensive ZPC achieved safe and efficacious results, which is hugely important for future clinical applications when considering the production cost of ZPC. More studies must be done to establish minimum dosing while achieving safe and efficacious outcomes.

[Rectal mucosa metastasis in recurrent prostate cancer : (68)Ga-PSMA-PET/CT allows targeted salvage radiotherapy]. / Rektummukosametastase beim Prostatakarzinomrezidiv : (68)Ga-PSMA-PET/CT ermöglicht eine gezielte Salvagestrahlentherapie.

This article presents for the first time a case of rectal mucosa metastasis of recurrent prostate cancer that was diagnosed with (68)Ga-PSMA PET/CT. After histological confirmation, the patient was treated with salvage radiotherapy. This case report underlines the specificity and efficacy of PSMA-based PET imaging. In case of biochemical relapse, it can be used even at low PSA levels to detect prostate cancer metastases that might also be in atypical locations. Thus, (68)Ga-PSMA PET/CT may allow new options for salvage therapy.

A lipidomic analysis approach in patients undergoing lipoprotein apheresis.

Lipoprotein apheresis such as heparin-induced extracorporal LowDensityLipoprotein (LDL) Cholesterol precipitation (HELP) reduces apolipoprotein B-containing lipoproteins, most importantly low-density-lipoprotein (LDL), and lipoprotein (a) [Lp(a)]. It is used in patients with atherosclerotic disease and therapy-refractory hypercholesterolemia or progressive atherosclerotic disease in patients with elevated Lp(a). While lipid-lowering effects of lipoprotein apheresis are well-established, there are only sparse data regarding the effect of apheresis on individual omega-6 and omega-3 polyunsaturated fatty acids (n-6 PUFA and n-3 PUFA), such as arachidonic acid (AA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which could increase (AA) or decrease (EPA and DHA) cardiovascular risk. Here we analyzed different omega-6 and omega-3 fatty acids in the blood of patients undergoing a single HELP apheresis procedure using gas chromatography (GC). Furthermore, we assessed the effect of HELP treatment on formation of lipid metabolites and mediators arising from these polyunsaturated fatty acids in the plasma by LC/ESI-MS/MS. Lipoprotein apheresis reduced the concentrations of fatty acids analyzed in the plasma by 40-50%. This was similar for AA, EPA and DHA. The reduction in fatty acid plasma levels was similar to the reduction of total triglycerides. However there was a trend towards an increase of PUFA metabolites associated with platelet activation, such as 12-hydroxyeicosatetraenoic acid (12-HETE) and 14-hydroxydocosahexaenoic acid (14-HDHA). These data indicate that HELP apheresis could interfere with achieving higher levels of n-3 PUFA in the plasma. Lipid apheresis treatment might also increase the formation of potentially pro- as well as anti-inflammatory lipid mediators derived from AA or EPA and DHA.

SmartSenior@home: Acceptance of an integrated ambient assisted living system. Results of a clinical field trial in 35 households.

AIMS: The primary objective of the SmartSenior@home study was to examine the acceptance of the SmartSenior system by older adults. METHODS: Twenty-eight partners from industry and research, including the health care sector, worked collaboratively to implement services aiming to maximize independence in old age. The prospective cohort study was conducted in Potsdam, Germany, with n = 35 older adults between 55 and 88 years of age in their apartments. All participants underwent extensive pre- and post-study visits with in-home interviews, functional assessments for cognition, fine motor skills, and mobility as well as responding to questionnaires on user acceptance and quality of life. RESULTS: The results indicate moderate-to-high user acceptance for the SmartSenior system. In particular, the services for general assistance and health, such as audio/video communication, blood pressure monitoring, and communication with a health professional, were rated as very attractive. Less used and less accepted services were those promoting social interaction and reminder services. CONCLUSION: Besides reliable functioning of the SmartSenior system, the availability of a confidant seems to be the most significant acceptance factor. As one conclusion of this trial, it is possible to develop, integrate, and test an infrastructure for ambient assisted living services in real life.

Prevalence and definition of sarcopenia in community dwelling older people. Data from the Berlin aging study II (BASE-II).

BACKGROUND: Sarcopenia describes the age-associated loss of muscle mass, strength and function. The aim of this study was to compare the prevalence of sarcopenia in a cohort of community dwelling elderly people living in Berlin, Germany, according to the criteria proposed by current consensus statements and to study the respective impact on self-reported physical performance. MATERIAL AND METHODS: This study included 1405 participants from the Berlin aging study II (BASE-II). The appendicular skeletal muscle mass index (SMI) was assessed with dual energy X-ray absorptiometry (DXA), muscle strength was measured by hand grip strength and the timed up and go" test (TUG) was performed as a functional parameter to reflect mobility. RESULTS: The prevalence of sarcopenia was 24.3 % in terms of reduced SMI only and considerably lower for sarcopenia with reduced grip strength (4.1 %) and sarcopenia with limited mobility (2.4 %). Only 0.6 % of the participants fulfilled all three criteria. Of the subjects with a normal SMI, 8.6 % had reduced grip strength and 5.1 % had limited mobility, whereas 1.3 % subjects fulfilled both criteria. Participants with reduced strength or function reported severe difficulties in performing physical tasks significantly more often than participants with normal or reduced SMI alone (p <0.029-p <0.0001). CONCLUSION: In BASE-II low skeletal muscle mass was much more frequent than reduced grip strength or poor function. Reduced strength and function were found to be associated with a greater impact on physical performance than reduced muscle mass. Low SMI does not seem to be a prerequisite for low strength or limitations in mobility.

Multimodal sensor-based fall detection within the domestic environment of elderly people.

BACKGROUND: Falls represent a major threat to the health of the elderly and are a growing burden on the healthcare systems. With the growth of the elderly population within most societies efficient fall detection becomes increasingly important; however, existing fall detection systems still fail to produce reliable results. OBJECTIVES: A study was carried out on sensor-based fall detection, analysis of falls with the help of fall protocols and the analysis of user acceptance of fall detection sensor technology through questionnaires. MATERIAL AND METHODS: A total of 28 senior citizens were recruited from a German community-dwelling population. The primary goal was a sensor-based detection of falls with accelerometers, video cameras and microphones. Details of the falls were analyzed with the help of medical geriatric assessments and standardized fall protocols. The study duration was 8 weeks and required a maximum of nine visits per subject. RESULTS: The study participants were 28 subjects with a mean age of 74.3 and a standard deviation (SD) of ± 6.3 years of which 12 were male and 16 female. A total of 1225.7 measurement days were recorded from all participants and the algorithms detected 2.66 falls per day. During the study period 15 falls occurred and 12 of these falls were correctly recognized by the fall detection system. CONCLUSION: Current fall detection technologies work well under laboratory conditions but it is still problematic to produce reliable results when these technologies are applied to real life conditions. Acceptance towards the sensors decreased after study participation although the system was generally perceived as useful or very useful.

[New AHA and ACC guidelines on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk : Statement of the D•A•CH Society for Prevention of Cardiovascular Diseases, the Austrian Atherosclerosis Society and the Working Group on Lipids and Atherosclerosis (AGLA) of the Swiss Society for Cardiology]. / Neue AHA- und ACC-Leitlinie zur Risikoreduktion von Herz-Kreislauf-Erkrankungen durch Cholesterinsenkung : Stellungnahme der D•A•CH-Gesellschaft Prävention von Herz-Kreislauf-Erkrankungen e. V., der Österreichischen Atherosklerose Gesellschaft und der Arbeitsgruppe Lipide und Atherosklerose (AGLA) der Schweizer Gesellschaft für Kardiologie.

Guidelines for the reduction of cholesterol to prevent atherosclerotic vascular events were recently released by the American Heart Association and the American College of Cardiology. The authors claim to refer entirely to evidence from randomized controlled trials, thereby confining their guidelines to statins as the primary therapeutic option. The guidelines derived from these trials do not specify treatment goals, but refer to the percentage of cholesterol reduction by statin medication with low, moderate, and high intensity. However, these targets are just as little tested in randomized trials as are the cholesterol goals derived from clinical experience. The same applies to the guidelines of the four patient groups which are defined by vascular risk. No major statin trial has included patients on the basis of their global risk; thus the allocation criteria are also arbitrarily chosen. These would actually lead to a significant increase in the number of patients to be treated with high or maximum dosages of statins. Also, adhering to dosage regulations instead of cholesterol goals contradicts the principles of individualized patient care. The option of the new risk score to calculate lifetime risk up to the age of 80 years in addition to the 10-year risk can be appreciated. Unfortunately it is not considered in the therapeutic recommendations provided, despite evidence from population and genetic studies showing that even a moderate lifetime reduction of low-density lipoprotein (LDL) cholesterol or non-HDL cholesterol has a much stronger effect than an aggressive treatment at an advanced age. In respect to secondary prevention, the new American guidelines broadly match the European guidelines. Thus, the involved societies from Germany, Austria and Switzerland recommend continuing according to established standards, such as the EAS/ESC guidelines.

[Polypharmacy and drug prescription in the elderly. Strategies for optimization]. / Polypharmazie und Arzneimitteltherapiesicherheit im Alter. Strategien zur Verbesserung.

BACKGROUND: When used appropriately, drugs are an effective and efficient intervention in the care of patients. However, elderly, multimorbid patients are especially prone to adverse side effects caused by the simultaneous intake of many drugs--this effect is called polypharmacy. Furthermore, adverse medical effects occur more frequently with elderly people compared to younger patients. This is due to age-specific metabolic changes and issues with compliance and adherence. Therefore, the indication for medication should be taken carefully and individually especially for elderly patients, in order to develop a realistic risk-benefit ratio, taking into consideration questions like quality of life and life expectancy. MATERIALS AND METHODS: In this paper, the current medical care situation of elderly people is presented; problems are identified and analyzed. RESULTS: Supported by a selected literature search, recommendations for improving medication safety are summarized.

Extended-release niacin/laropiprant for lipid management: observational study in clinical practice.

AIMS: Patients with dyslipidaemia or hypercholesterolemia carry a substantially increased cardiovascular risk and need optimal treatment of this key risk factor. We aimed to investigate the utilisation, efficacy and tolerability of the single pill combination extended-release niacin/laropiprant 1000 mg/20 mg or 2000 mg /40 mg under conditions of primary care practice. METHODS: The present study was a prospective, non-interventional, observational study involving 885 primary care physicians throughout Germany. Data on adult patients treated with niacin/laropiprant one or two tablets daily within the labelled indication were documented for an average of 23 ± 7 weeks. The study was registered in the Association of research-based pharmaceutical companies (VFA) database under no. 354. RESULTS: A total of 2359 patients were analysed in the intent-to-treat population (mean age 61.1 years, 67% males) of whom 1917 could be followed up. Background statin therapy was often discontinued and only about 50% of patients received two tables niacin/laropiprant at the end of the study. Individual goal attainment rates as subjectively determined by the investigator were for LDL-C 59.4%, total cholesterol 59.5%, HDL-C 72.8% and TG 51.5%, respectively. Objective (laboratory) goal attainment rates according to NCEP ATP III criteria were lower: LDL-C <100 mg/dl goal was achieved in 17.8%, HDL-C >40 in males or >50 mg/dl in females in 37.9% and TG <150 mg/dl in 18.7%. Totally, 422 adverse events were noted in 231 patients (9.7%), of which 317 were considered drug-related. Flushing occurred in 15%. CONCLUSION: Niacin/laropiprant resulted in beneficial effects on serum lipids and was generally well tolerated. The full potential of the drug combination was not explored by most physicians due to discontinuation of statins and lack of titration of the combination. Overall, treatment effects were consistent with those seen in controlled trials.

[Cross-sectional field Q7"medicine of aging and the elderly" at the Charité - Universitätsmedizin Berlin : Curriculum and evaluation by students]. / Der Querschnittsbereich Q7 "Medizin des Alterns und des alten Menschen" an der Charité - Universitätsmedizin Berlin : Curriculum und Evaluation durch Studierende.

AIMS: There have only been a few publications focussing on how the curriculum Q7 "medicine of aging and the elderly" is implemented at German medical schools. In order to stimulate discussion about the implementation of Q7 the authors present the results of a survey of medical students of the Charité - Universitätsmedizin Berlin. The aim of the survey was to identify items that contribute to a good course and thus improve the quality of lectures and courses in geriatric medicine with the overall aim to encourage more students to become geriatricians after their studies. MATERIALS AND METHODS: Medical students from the fifth clinical semester were interviewed in anonymous form following each course using standardized questionnaires for organizational and didactic topics. Factor analysis, proof of reliability, descriptive statistics and correlation analysis were performed as statistical methods. RESULTS: The proof of reliability of questionnaires showed good internal consistency with Cronbachs alpha values of 0.88 (seminars), 0.91 (lectures) and 0.92 (bedside teaching). The overall response rate was very high (95.3%, n = 803 questionnaires). The ratings for questionnaire items in the three teaching formats (i.e. seminars, lectures, bedside teaching) ranged mostly from good to very good. In the correlation analysis across all three teaching formats clear communication of learning objectives, the treatment of topics according to their own expectations and the learning experience were rated as most relevant overall. CONCLUSIONS: The evaluation results indicate a high level of satisfaction with the curriculum of geriatrics at the Charité, which can therefore be recommended across faculties taking into account the criteria named.