Atherogenic versus non-atherogenic lipoprotein profiles in healthy individuals. is there a need to change our approach to diagnosing dyslipidemia?

The electrophoretic separation of lipoproteins on polyacrylamide gels enables the quantification of nonatherogenic and atherogenic plasma lipoproteins including small dense low density lipoprotein (sdLDL) particles, which represent the atherogenic lipoprotein subpopulations in plasma. This methodology could help distinguish between nonatherogenic hyperlipidemia, normolipidemia with an atherogenic lipoprotein profile, non-atherogenic normolipidemia, and atherogenic hyperlipidemia. According to our pilot research of a normolipidemic population, the atherogenic lipoprotein profile might be present in about 6% of normolipidemic young healthy individuals. Therefore, if confirmed by other studies, it will be necessary to consider a different diagnostic approach and risk stratification for patients with atherogenic normolipidemia (as well as non-atherogenic hypercholesterolemia).

[Present and future of pharmaco-arteriothromboprophylaxis in clinical practice. Guidelines of Angiology Section of Slovak Medical Chamber]. / Súcasnost a budúcnost farmako-artériotromboprofylaxie v klinickej praxi. Odporúcania Angiologickej sekcie Slovenskej lekárskej komory.

Antiplatelet therapy by acetylsalicylic acid (aspirin) provided pivotal advances in the prevention and treatment of organovascular (cardiovascular, cerebrovascular, extremitovascular, renovascular, genitovascular, mesenteriovascular, bronchopulmovascular, oculovascular, otovascular and other) arterial ischemic diseases. Currently available antiplatelet drugs have some limitations which might be overcomed by improved dosing regimens, use of combination of agents affecting different platelet functions and, in particular, by the new antiplatelet drugs (new arterial antithrombotics) with distinct pharmacodynamic properties offering new advantages, including faster onset of action, greater potency, and reversibility of effects. Document (Guidelines) of the Angiology Section of the Slovak Medical Chamber (AS SMS, 2013).

[Management of superficialis thrombophlebitis. Guidelines of the Angiologiy Section of the Slovak Medical Chamber (2013)]. / Manazment povrchovej tromboflebitídy. Odporúcania Angiologickej sekcie Slovenskej lekárskej komory (2013).

UNLABELLED: The aim of Guidelines of the Angiology Section of the Slovak Medical Chamber (AS SMC) is to address a last european guidelines for the management of thrombophlebitis superficialis, as well as results in evidence based  medicine (EBM) in order to assess their contribution to our expanding knowledge on rational management of thrombophlebitis superficialis. DISCUSSION: Superficial thrombophlebitis is a common disease, usually considered to be benign. However, the practice of systemic duplex ultrasonography has revealed a large number of cases of deep vein thrombosis concomitant with superficial thrombophlebitis. Assessment of clinical probability of deep vein thrombosis and venous tromboembolism and systematic duplex ultrasound investigation has been proposed in the initial management of superficial thrombophlebitis, to detect the presence of any underlying deep vein thrombosis. In contrast with extensive information on the management of deep vein thrombosis, there is little knowledge about the most appropriate treatment of the superficial thrombophlebitis. CONCLUSION: The treatment of superficial thrombophlebitis should improve local symptoms while preventing the development of complications such as venous thromboembolism. The most effective therapeutic approach to superficial thrombophlebitis seems to be represented by fondaparinux (a synthetic selective indirect inhibitor of factor Xa) which have been shown to prevent VTE events and the extension and/ or recurrence of superficial thrombophlebitis.

[Management of dyslipidaemias -  present and future. Guidelines of the Angiology Section of the Slovak Medical Chamber (2013)]. / Manazment dyslipidémií -  prítomnost a budúcnost. Odporúcania Angiologickej sekcie Slovenskej lekárskej komory (2013).

AIM: The aim of Guidelines of the Angiology Section of the Slovak Medical Chamber is to address a last European guidelines for the management of dyslipidaemias, as well as results in evidencebased medicine (EBM) in order to assess their contribution to our expanding knowledge on reducing of residual organovascular risk. DISCUSSION: Lipid metabolism can be disturbed in different ways, leading to changes in plasma lipoprotein function and/ or levels. This by itself and through interaction with other vascular risk factors and endothelial dysfunction may affect the development of atherosclerosis and other vascular diseases. Therefore, dyslipidaemias cover a broad spectrum of lipid abnormalities, some of which are of great importance in organovascular prevention. Dyslipidaemias may be related to other diseases (secondary dyslipidaemias) or to the interaction between genetic predisposition and environmental factors. Dyslipidaemias may also have a different meaning in certain subgroups of patients which may relate to genetic predisposition and/ or co morbidities. This requires particular attention complementary to the management of the total CV risk. Optimal LDLcholesterol levels are the primary strateging task in the therapeutical preventive approaches. However, at present increasing attention has focused on the role of inflamation, levels of HDLcholesterol and triglycerides in the process of atherosclerosis. Statins represent basic pillar in dyslipidemia treatment. Despite the intensive management of all conventional vascular risk factors and the intensified treatment with statins, residual organovascular risk remains high. Therefore the interest is focused on finding the place of combined antidyslipidemic treatment and the development of new antidyslipidemics. CONCLUSION: Strategies for preventing of organovascular diseases have emphasized vascular risk factors effective modification using treatment approaches supported by evidencebased medicine (EBM).

[Lipids and the size of lipoprotein particles in newly diagnosed and untreated patients with type 2 diabetes mellitus]. / Lipidy a velkost lipoproteínových castíc u pacientov s novozisteným a doposial nelieceným diabetes mellitus 2. typu.

Type 2 diabetes mellitus leads to the typical known form of dyslipidaemia among the patients. This dyslipiademia type re-presents prognostically important type of atherogenic dyslipiadaemia, that significantly increases the risk of atherothrombosis. Estimation of the size of lipoprotein particles with Lipoprint method among newly diagnosed, untreated patients with these patients have not been evaluated yet. Dyslipidaemia among patients with type 2 diabetes mellitus has its course and changes after the treatment. At the beginning i tis characterized by the significant increase of VLDL, large and middle size IDL lipoprotein particles, as well as by lowering of HDL particles. This lipoprotein profile has its own atherogenic potential. The course of the disease later leads to the change of dyslipidaemia, characterized by the increase of LDL levels (small dense particles), triglyceride levels and the persistence of the lower levels of HDLcholesterol. Hypolipidemic treatment leads to the significant lowering of cardiovascular risk, however despite treatment with statin or fibrate residual cardiovascular risk remains still very high.

[Multiple-combination kinezio-phlebothromboemboloprophylaxis, mechano-phlebothromboemboloprophylaxis and pharmaco-phlebothromboemboloprophylaxis of venous thromboembolism in internal medicine]. / Kombinovaná kinezio-flebotromboemboloprofylaxia, mechano-flebotromboemboloprofylaxia a farmako-flebotromboemboloprofylaxia vénovej tromboembólie v internej medicíne.

Parenteral heparin and oral coumarin preparations represent the standard antithrombotics widely used in the prevention and treatment of venous thromboembolism (VTE). Unfractionated heparin, low molecular weight heparins, and fondaparinux have been shown to be effective and safe in reducing VTE risk. Despite high efficacy these medicaments have limitations which become to be more apparent with current widening of the indications for either primary thromboprophylaxis (PTP) or indefinite and even lifelong secondary thromboprophylaxis (STP). There is a need for new effective and safe medicaments with specific antithrombotic action, oral administration and convenient dosing without monitoring. During the last decade new antithrombotics have been developed either blocking selectively one coagulation enzyme or inhibiting particular step in coagulation cascade. Document of the Angiologists Section of the Slovak Medical Chamber (AS SMC).

[The incidence of dyslipidemia in a sample of asymptomatic probands established by the means of Lipoprint system]. / Výskyt aterogénnej dyslipidémie vo vzorke asymptomatických probandov vysetrením pomocou metódy Lipoprint.

Method of lipoprotein determination on polyamideacryl gel Lipoprint enables an exact quantification nonatherogenic and atherogenic plasma lipoproteins. For its use in human medicine this method was recently approved by FDA. According to majority of nonatherogenic, or atherogenic lipoproteins in their spectrum this method can distinguish nonatherogenic type A vs atherogenic type B. After their identification, there is the possibility for exact means of interventions among patients with higher cardiovascular risk. Also in the group of clinically healthy asymptomatic controls with normolipemia it is possible using this method to estimate the certain group of risk of development of premature atherothrombosis.

Contribution of the atherogenic lipoprotein profile to the development of arterial hypertension.

OBJECTIVES: Determination of non-atherogenic and atherogenic plasma lipoproteins, including small dense LDL, in patients with newly diagnosed arterial hypertension and identification of the phenotype of lipoprotein profile: non-atherogenic phenotype A vs. atherogenic lipoprotein phenotype B, in plasma of examined subjects. BACKGROUND: Atherogenic lipoproteins play an important role in the pathogenesis of arterial hypertension. Impaired lipoprotein metabolism results in overproduction of triglyceride-rich particles and LDL 3-7 subfractions - small dense LDL - a strongly atherogenic LDL subpopulation accelerating the development of arterial hypertension. METHODS: Total cholesterol and triglycerides were analyzed by enzymatic CHOD-PAP method, Roche Diagnostics, Germany. Lipoprotein profiles of plasma described as atherogenic lipoprotein phenotype B or a nonaterogenic lipoprotein phenotype A were examined by a new method of lipoprotein separation by means of electrophoresis on polyacrylamide gel (Lipoprint LDL system). Prostacyclin and thromboxane A2 in plasma were analysed by ELISA method. Score of Atherogenic Risk was determined as a ratio of atherogenic and non-atherogenic plasma lipoproteins. RESULTS: 1) High percentage of atherogenic hypertriacylglycerolemia (93%) and atherogenic mixed hyperlipemia (86 %) in subjects with arterial hypertension. 2) Low percentage of atherogenic hypercholesterolemia (52 %) in subjects with arterial hypertension. 3) Atherogenic normolipemia (7%) in control group of healthy subject. CONCLUSION: Contribution of this method lies in benefits as follows: A) Quantification of non-atherogenic and atherogenic plasma lipoproteins. B) Identification of high percentage of atherogenic dyslipoproteinemia (86-93%) in subjects with arterial hypertension. C) Presence of small dense LDL in plasma is decisive for declaring the atherogenic lipoprotein profile in both hyperlipemia and normolipemia (Tab. 5, Ref. 24).

[Serum lipoprotein profile in newly recognized arterial hypertension. The role of atherogenic lipoproteins in the pathogenesis of disease]. / Lipoproteínový profil séra pri novozistenej artériovej hypertenzii. Uloha aterogénnych lipoproteínov v patogenéze ochorenia.

New examination approaches in biochemical analysis of lipoproteins can identify and quantify atherogenic plasma lipoproteins, including small dense LDL and characterise a lipoprotein spectrum as a non-atherogenic lipoprotein profile phenotype A, respectively as an atherogenic lipoprotein profile phenotype B. Identification of a non-aterogenic hypercholesterolemia (48%), atherogenic hypertriglyceridemia (93%), atherogenic normolipemia (13%) in patients with arterial hypertension and an atherogenic normolipemia in control group of healthy subjects (7%), is an essential contribution of this new laboratory diagnostics.

[Prevention and treatment of extremity vascular ischemic disease]. / Preventia a liecba koncatinovocievnej ischemickei choroby.

Extremitovascular ischemic disease (peripheral arterial disease of extremities - PAD) is an important manifestation of systemic atherosclerosis and other arterial diseases of vascular system. The lower the anklebrachial pressure index, the greater the risk of serious cardiovascular events (e.g., acute myocardial infarction, stroke). Prevention and treatment ofextremitovascular disease is discussed in this article.

[Changes in lipoprotein spectrum in patients with the diagnosis of extremity vascular ischemic disease]. / Zmeny v lipoproteínovom spektre pri koncatinovo-cievnej isthemickej chorobe.

New method of lipoprotein determination on polyacrylamid gel with Lipoprint LDL system quantifies non atherogenic and atherogenic plasma lipoproteins, including small dense LDL, the potent atherogenic lipoprotein subpopulations. According to majority of non atherogenic versus atherogenic lipoprotein in the whole lipoprotein spectrum, this method distinguishes a non atherogenic lipoprotein profile phenotype A from an atherogenic lipoprotein profile phenotype B. Definitely, the contribution of this method is focusing on the atherogenic lipoprotein profile phenotype B in 80% of patients with an extremito-vascular ischemic disease and on the existence of control subgroup ofnormolipemic subjects with an atherogenic lipoprotein profile (7% ofprobands of control group). These persons represent a risk population. Till now, the facilities for identifying of these "normolipemic persons at risk" are limited.

Management of pituitary macroprolactinoma in a 27-year-old male patient from Taiwan.

OBJECTIVES: The aim is to document the success of bromocriptine pharmacotherapy in a patient with gigantoprolactinoma. RESULT: The management of the patient was not appropriate at the beginning, because he underwent an operative therapy after the ophthalmological examination and MR without previous internal--endocrinological examination and pharmacotherapy. The endocrinologist participated in the patient management later, after the unsuccessful operative and when the patient's status was characterized by hyperprolactinaemia 15,000 ug/l and by hypopituitarism. Bromocriptine therapy immediately at the beginning would enable the patient to avoid several surgical interventions and subsequent complications with a high probability. CONCLUSION: The case report presents the failures at the beginning of diagnostic and therapeutic management of the patient with hyperprolactinaemia due to macroprolactinoma. It is both the example and the proof of irretrievability of general internal medicine, endocrinology and other internal disciplines in clinical practice. It confirms the integrating and coordinating function of the internal medicine specialist in clinical medicine (Tab. 1, Ref. 13).

[Epidemiology of vascular disease]. / Epidemiológia cievnych chorôb.

In the European Union are vascular diseases the main cause of death, causing 1.9 millions of deaths per year. The highest mortality rates for cardiovascular diseases are found in Slovakia (data provided by National center health information, 2006). In 2007 died 29,289 (54.1%) persons from cardiovascular diseases, which means more than half of all deaths. From all men 47.8% died from cardiovascular diseases and from all women died 61.6% for cardiovascular disease. Coronary heart disease (55%) presents more than half causes of these deaths. Despite that mortality from cardiovascular disease has been continuously decreasing, in Central and East European countries it is still kept in high rates.

[Venous thromboembolism in an oncology patient]. / Vénová tromboembólia u onkologického pacienta.

Venous thromboembolism is a common complication in many patients with different types of malignant tumors. In this paper we describe a case of a patient with cancer in remission, who developed pulmonary embolism.

Reccurent erythema migrans as a persistent infection.

BACKGROUND: Effective antibiotic therapy administered early in the course of the clinical presentation of erythema migrans (EM) prevents further progression of infection and dissemination of the agent to internal organs. CASE REPORT: A 73-year old woman was referred with a history of five episodes of recurrent EM after repeated adequate antibiotic treatment. The patient who had visited an endemic area only once before the disease recalled no tick bite either prior to the first episode or later. After the first episode, the serological examination was negative (IFA, ELISA, Western blot). In the second episode, not preceded by her visit to any endemic area, the patient showed borderline positivity. Western blot confirmed Borrelia burgdorferi sensu lato. The following episodes were observed again without a prior visit to any endemic area. The most recent EM episode was accompanied by nonspecific moderate symptoms such as fatigue and malaise without involvement of internal organs, with the same serological result as found previously. Peripheral blood PCR assay detected Borrelia burgdorferi specific DNA. Intravenous cephalosporin was effective in treating both the skin and extracutaneous signs of the disease. CONCLUSION: Recurrent episodes of appropriately treated EM may occur as a result of either reinfection due to contact with another vector tick or persistent infection. Intravenous cephalosporin is likely to be appropriate therapy for recurrent borrelial infection in the skin, in particular when accompanied by general extracutaneous signs and symptoms that might indicate dissemination of the spirochetes.

[Genetic factors and the risk of cardiovascular diseases]. / Genetické faktory a riziko kardiovaskulárnytch ochorení.

The objective of the study is to summarise the hereditary factors of cardiovascular diseases based on current knowledge, focus will be applied to genetic markers of multifactorial forms of cardiovascular diseases based on atherosclerosis, including their interaction with traditional risk factors.

[The role of infection and inflammation in the pathogenesis of atherosclerosis]. / Uloha infekcie a zápalu v patogenéze aterosklerózy.

Pathogenesis of the atherosclerotic process is deemed as multifactorial. To the most important risk factors, besides certain family predisposition, there belongs hypercholesterolemia, arterial hypertension, obesity, diabetes mellitus, smoking and others. In the last years there are more and more data about the role of inflammation and infection in the whole development of atherosclerosis. The witness for this hypothesis is the findings of high parameters of inflammation in involved vessels as well as in the blood of atherosclerosis suffering persons. Opinions about the inflammation theory appear from the 90th. Local sterile inflammation in the subendotelium of the middle and big arteries has been proved to consist of specific immune reaction (activation of the T-lymphocytes) as well as nonspecific characteristic by elevated monocytes in the artery wall during the whole process of atherogenesis. Inflammation in the plaque can trigger and hold several factors engaged in the atherosclerotic process, such as oxidized LDL cholesterol, elevated production of various superoxides, activated macrophages, activated T-lymphocytes, cytokines (IL-1, IL-6, interferon gamma) and lipoprotein Lp (a). In this inflammation process levels of CRP (acute phase protein), fibrinogen and erythrocyte sedimentation are elevated as a reaction of the organism to nonspecific chronic infections. Because of this it is thought that elevated fibrinogen and erythrocyte sedimentation are markers of the cardiovascular risk. Some papers deal with antiinflammatory effects of statins, because these lower CRP levels so they also lower atherosclerotic risk through not only lowering of cholesterol levels. Also asprine, as an antiinflammation agent, changing the CRP levels, would be of benefit for patients with vascular disease because its antiaggregation and antiinflammatory effects. ACE inhibitors are also antiinflamatory through blocking of tissue production of angiotensin II (artery wall and atherosclerotic plaque). Enzymatic inhibitors changing angiotensin can also have a partial antiinflammatory effect. The infection theory is supported also by tracing of some microorganisms in the atherosclerotic plaque or in the blood, as e.g. Helicobacter pylori or Chlamydia pneumoniae; to the autoimmune origin is indicated the presence of the specific immunity reaction against heat shock proteins (HSP) or oxidized LDL. This infection theory offers new therapy possibilities. Therefore eradication for example by antibiotics can lead to stabilization of the atherosclerotic plaque with positive consequences, as it was discovered by many studies.