Significance of Atrial Fibrillation Complicating ST-Segment Elevation Myocardial Infarction.

The aim of the present study is to assess the clinical impact of atrial fibrillation (AF) in patients with ST-segment elevation myocardial infarction (STEMI) complicated by new-onset AF depending on STEMI location and timing of arrhythmia. We analyzed 4,363 consecutive STEMI patients treated invasively. Finally, 4,099 subjects were included into further analysis, as 264 patients were excluded because of previous AF history. In total, 1,800 (43.9%) subjects with anterior infarction were included into Group 1, whereas Group 2 encompassed 2,299 (56.1%) patients with nonanterior infarction. Subsequently, both groups were divided into patients with new-onset AF (AF Group 1 and 2, respectively) and without AF (Control Group 1 and 2). New-onset AF was recognized in 225 patients (5.5%): 96 (5.3%) with an anterior wall infarction (AF Group 1) and 129 (5.6%) with a nonanterior wall infarction (AF Group 2). The incidence of early-onset arrhythmia (within 24 hours after admission) was significantly higher in AF Group 2 than in AF Group 1: 71.3% versus 35.4% (p <0.001). In Group 1, both early- and late-onset AFs were associated with significantly increased in-hospital mortality compared with AF-free population (17.7% and 27.4%, respectively vs 6.3%; p <0.05), whereas in Group 2, in-hospital mortality was increased only in subjects with late-onset AF compared with AF-free population (13.5% vs 4.2%, p <0.05). New-onset AF was the independent predictor of death only in Group 1 (hazard ratio 2.16) and this effect was stronger for late-onset AF (hazard ratio 2.86). In conclusion, 1 in 20 patients with STEMI treated invasively was affected by new-onset AF. The predictive value of new-onset AF was strongly related with STEMI location and timing of arrhythmia.

Prognostic significance of HbA1c in patients with AMI treated invasively and newly detected glucose abnormalities.

BACKGROUND: Glucose abnormalities are frequent comorbidities influencing prognosis in patients with cardiovascular diseases. The objective of this study was to evaluate prognostic role of HbA1c in patients with acute myocardial infarction (AMI) treated invasively, who had newly detected glucose abnormalities. DESIGN: Single-centre registry encompassed 2146 survivors of AMI. In all patients without diabetes mellitus (DM), oral glucose tolerance test was performed before hospital discharge and interpreted according to the guidelines. METHODS: From the study population, two major groups with defined new glucose abnormalities and estimated HbA1c were selected: 457 patients with impaired glucose tolerance (IGT) and 306 patients with newly detected DM (newDM). In each of these groups, the median value of HbA1c was calculated and established as the cut-off point for further analysis. The median HbA1c for IGT group was 5.9% and for newDM was 7.0%. RESULTS: Patients with IGT and HbA1c ≤ 5.9% had significantly lower posthospital mortality (4.5%) than those with HbA1c >5.9% (25.0%; p<0.001). Similarly, patients with newDM and HbA1c ≤7.0% had lower mortality (6.4%) than those with HbA1c >7.0% (14.3%; p<0.05). Multivariate regression analysis revealed that increase of HbA1c was one of the strongest independent risk factors of death among IGT patients (HR 2.9, 95% CI 2.7-3.1; p < 0.001) and newDM (HR 1.53, 95% CI 1.39-1.66; p<0.05). CONCLUSIONS: Increase of HbA1c in patients with newly detected glucose abnormalities was associated with significantly reduced survival after AMI treated invasively. Moreover, increase of HbA1c in patients with IGT and newDM was one of the strongest independent risk factors of death in these populations.

Role of impaired glucose tolerance in patients with acute myocardial infarction in relation to sex.

INTRODUCTION: Impaired glucose tolerance (IGT) has a negative impact on the outcome of patients with acute myocardial infarction (AMI). OBJECTIVES: The aim of the study was to compare the effect of IGT on early and late prognosis in women and men with AMI treated with percutaneous coronary intervention (PCI). PATIENTS AND METHODS: Based on the results of oral glucose tolerance test, 560 patients with IGT (395 men, 165 women) were selected out of a single center registry of 2733 consecutive patients with AMI. Sex­related mortality and major adverse cardiovascular events (MACEs) including myocardial reinfarction, stroke, or repeat revascularization during hospitalization and long­term follow­up were compared in the whole study population and within the high­risk subgroups. RESULTS: Mortality and MACE rates were comparable between men and women except for a higher stroke rate in women (4.8% vs. 1.5%, P <0.05). No significant differences were observed in the subgroups of patients with reduced ejection fraction (<35%) and those aged above 70 years, during both short and long­term follow­up. However, in women compared with men, higher stroke rates were observed in the subgroup of patients with incomplete revascularization (6.9% vs. 1.1%, P <0.05) and higher total mortality rates in the subgroup with renal dysfunction (40% vs. 16%, P <0.05). Female sex was an independent risk factor for stroke (hazard ratio [HR], 2.94; P = 0.048) and MACEs (HR, 1.45; P = 0.009), but not for death, in the population of patients with AMI and IGT. CONCLUSIONS: Mortality in women and men with AMI treated with PCI with concomitant IGT is comparable, but female sex is an independent risk factor for stroke and MACEs, particularly worsening prognosis in patients with renal dysfunction.

The incidence and risk factors of stroke in patients with acute myocardial infarction treated invasively and concomitant impaired renal function.

BACKGROUND: Impaired renal function is a marker of poor prognosis in patients with acute myocardial infarction (AMI). The aim of the study was to assess the incidence and independent predictors of stroke in population of patients with AMI treated invasively and concomitant impaired renal function (IRF). METHODS: We analyzed 2,520 consecutive AMI patients admitted to our Center between 2003 and 2007 and treated with percutaneous coronary intervention. The whole population was divided into patients with IRF, defined as glomerular filtration rate < 60 mL/min/1.73 m(2) or contrast induced nephropathy (IRF group, n = 933; 37.02%) and patients without IRF (control group, n = 1587; 62.98%). The IRF group was subjected to further analysis. Data on long-term follow-up were screened to identify the patients who experienced stroke. RESULTS: During median of 25.5 months of follow-up 52 (2.07%) the patients experienced stroke - 33 (3.54%) in the IRF group and 19 (1.2%) patients in the control group. The risk of major adverse cardiovascular events in the IRF group, including repeated AMI (68.8 vs.14.9%, p < 0.001) and death (45.5 vs. 25.1%, p < 0.05) was significantly higher in patients with stroke. Previous stroke (HR 6.85), female gender (HR 3.13), as well as STEMI anterior (HR 2.55) were independent risk factors of stroke in this population. CONCLUSIONS: Patients with AMI treated invasively and concomitant IRF were at higher risk of stroke occurrence in the future. Stroke was associated with poor outcome in the studied population. Independent predictors of stroke in patients with IRF and AMI treated invasively were different from commonly recognized stroke predictors.

The significance of heart rate turbulence in predicting major cardiovascular events in patients after myocardial infarction treated invasively.

INTRODUCTION: The role of heart rate turbulence (HRT) related to baroreflex sensitivity in predicting mortality after myocardial infarction (MI) has been confirmed by several investigators. However, the significance of HRT in predicting major adverse cardiovascular events (MACE) following acute MI is unknown. PURPOSE: To analyze the prognostic value of HRT and other independent risk factors associated with autonomic regulation of MACE. METHODS: HRT was assessed based on 24-hour Holter recordings in 500 patients (pts) with acute MI treated invasively (352 M, aged 60.58 years). Turbulence onset (TO,%), slope (TS, ms/RR interval) and timing (TT) were calculated. TO ≥ 0, TS ≤ 2.5 and TT ≥ 10 were considered abnormal; classic and own categories were defined. Time domain heart rate variability (HRV) parameters were also calculated. Within 30.1 ± 15.1 months of follow-up, MACE occurred in 116 pts. RESULTS: Abnormal TO, TS, and TT were significantly more frequent in patients with MACE (P < 0.05 for each parameter, classic and own categories). In long-term follow-up, the largest differences in MACE were observed in patients with own category comprising abnormal TO, TS, and TT. Combining HRT parameters with SDNN (total HRV index) augmented their predictive value. Independent risk factors for MACE were TT, SDNN and rMSSD (a parasympathetic activity index) (HR 2.44, 1.71 and 1.69 respectively; P < 0.05). CONCLUSION: Abnormal HRT distinguishes patients at risk of MACE after MI. Own category encompassing three abnormal HRT parameters best differentiates patients at risk of MACE. Turbulence timing is a strong independent risk factor for MACE following MI.

The prognostic value of different glucose abnormalities in patients with acute myocardial infarction treated invasively.

BACKGROUND: Diabetes (DM) deteriorates the prognosis in patients with coronary heart disease. However, the prognostic value of different glucose abnormalities (GA) other than DM in subjects with acute myocardial infarction (AMI) treated invasively remains unclear. AIMS: To assess the incidence and impact of GA on clinical outcomes in AMI patients treated with percutaneous coronary intervention (PCI). METHODS: A single-center, prospective registry encompassed 2733 consecutive AMI subjects treated with PCI. In all in-hospital survivors (n = 2527, 92.5%) without the history of DM diagnosed before or during index hospitalization standard oral glucose tolerance test (OGTT) was performed during stable condition before hospital discharge and interpreted according to WHO criteria. The mean follow-up period was 37.5 months. RESULTS: The incidence of GA was as follows: impaired fasting glycaemia - IFG (n = 376, 15%); impaired glucose tolerance - IGT (n = 560, 22%); DM (n = 425, 17%); new onset DM (n = 384, 15%); and normal glucose tolerance - NGT (n = 782, 31%). During the long-term follow-up, death rate events for previously known DM, new onset DM and IGT were significantly more frequent than those for IFG and NGT (12.3; 9.6 and 9.4 vs. 5.6 and 6.4%, respectively, P < 0.05). The strongest and common independent predictors of death in GA patients were glomerular filtration rate < 60 ml/min/1,73 m^2 (HR 2.0 and 2.8) and left ventricle ejection fraction < 35% (HR 2.5 and 1.8, all P < 0.05) respectively. CONCLUSIONS: Glucose abnormalities are very common in AMI patients. DM, new onset DM and IGT increase remote mortality. Impaired glucose tolerance bears similar long-term prognosis as diabetes.

Microvolt T-wave alternans and other noninvasive predictors of serious arrhythmic events in patients with an implanted cardioverter-defibrillator.

BACKGROUND: Prediction of recurrent malignant ventricular tachyarrhythmias after insertion of a implantable cardioverter-defibrillator (ICD) is challenging. Microvolt T-wave alternans (MTWA) seems to be a promising marker of such events in ICD recipients. AIM: To assess prognostic significance of MTWA and other noninvasive parameters in the prediction of major arrhythmic events after ICD implantation. METHODS: This prospective study included 155 patients (121 male, age 59 ± 11 years) in whom ICD was implanted for secondary prevention of a sudden cardiac death. In all patients, clinical evaluation along with estimation of ejection fraction, MTWA measurement using the HearTwave Cambridge Heart system, and determination of the corrected QT interval (QTc) and QT dispersion (QTd) based on resting ECG were performed 3 days before ICD implantation. Using 24-h Holter monitoring, cardiac arrhythmias, QT interval, QT dynamicity, QT variability (QTSD) and heart rate variability (HRV) time domain parameters were determined. MTWA results were categorised, based on the accepted criteria, as positive, negative or indeterminate. In further analyses, positive and indeterminate MTWA results were grouped together as abnormal or non-negative tests [MTWA+], while negative MTWA results were considered normal [MTWA-]. During the follow-up (mean duration 21.6 ± 11.6 months), major arrhythmic cardiac events (MACE), defined as death and/or the need for ablation and/or heart transplantation due to malignant ventricular tachyarrhythmias, were recorded. RESULTS: During the follow-up, MACE occurred in 17 (11%) patients. Abnormal MTWA before ICD implantation was found significantly more frequently in patients with MACE as compared to patients without MACE. Multivariate Cox regression analysis identified abnormal MTWA and QTSD as independent risk factors for MACE, with hazard ratios of 10.82 (95% CI 9.76-11.88; p〈 0.05) and 1.08 (95% CI 1.05-1.08), respectively. Significant differences in MACE-free survival rate with regard to MTWA results (abnormal vs normal MTWA) were shown during the follow-up (p〈 0.001). The negative predictive value of normal MTWA for MACE was 98.6%. When both MTWA and QTSD were combined, the positive predictive value increased to 35%, with a sensitivity of 82% and specificity of 81%. The probability of MACE with normal results of both these tests was 2.3%. CONCLUSIONS: Abnormal MTWA is a strong independent predictor of MACE in ICD recipients, and QTSD is a weaker predictor. In the prediction of MACE after ICD implantation, the highest predictive value was noted for abnormal MTWA combined with QTSD. Normal values of these two parameters were associated with a low probability of MACE. These results suggest that standardised MTWA evaluation can be useful for risk stratification in the clinical practice.

The risk of stroke in patients with acute myocardial infarction treated invasively.

BACKGROUND: To assess the incidence, clinical significance, and independent risk factors of stroke in patients with acute myocardial infarction (AMI) treated invasively. MATERIALS AND METHODS: We analyzed 2520 consecutive patients with AMI admitted between 2003 and 2007. Data on long-term follow-up were screened to identify patients who had stroke. RESULTS: During a median of 25.5 months, 52 patients (2.07%) had stroke. The cumulative risk of stroke was the highest during the first year (1.23%) and particularly within the first month after AMI (0.28%). Patients with stroke were at a significantly higher risk of developing major adverse cardiovascular events, including repeated AMI (26.9 vs. 14.6%, P<0.05) and death (40.4 vs. 13.6%, P<0.001). Previous stroke [hazard ratio (HR) 5.89], female sex (HR 2.60), glomerular filtration rate <60 ml/min/1.73 m (HR 1.92), and contrast nephropathy (HR 1.87, all P<0.05) were independent predictors of stroke. The receiver-operating curve calculated for the Contrast nephropathy, renal Insufficiency, Female, prior Stroke (CIFS) risk scale demonstrated a significant predictive value of this scale (area under curve 0.73, P<0.001). Patients with the lowest, median, and highest risk scores (<4, 4-5, ≥6 points, respectively) differed significantly with regard to stroke incidence (2.1 vs. 7.9 vs. 14.0%, respectively, P<0.05). CONCLUSION: The risk of stroke is the highest within the first month after AMI. Stroke is a marker of unfavorable outcome in this population. Independent risk factors for stroke after invasive treatment of AMI are different from those commonly perceived as stroke predictors. A risk scale based on sex, stroke history, and renal impairment is useful in risk stratification.

The impact of unsuccessful percutaneous coronary intervention on short- and long-term prognosis in STEMI and NSTEMI.

OBJECTIVES: To compare the impact of the efficacy of percutaneous coronary intervention (PCI) on prognosis in ST and non-ST elevation myocardial infarction (STEMI and NSTEMI) patients with respect to infarct-related artery (IRA). BACKGROUND: The significance of the efficacy of PCI in STEMI and NSTEMI depending on the type of IRA has yet to be clarified. METHODS: Study population consisted of 2,179 STEMI and 554 NSTEMI consecutive patients treated with urgent PCI. The efficacy of PCI (TIMI [thrombolysis in myocardial infarction] 3 vs. TIMI < 3) was assessed with regard to the type of IRA (left anterior descending artery, circumflex artery [Cx] or right coronary artery). The mean follow-up was 37.5 months. RESULTS: The rate of unsuccessful PCI was similar in STEMI and NSTEMI irrespectively of IRA (14.1 vs. 17.7%; P = 0.062). In STEMI, unsuccessful PCI was associated with significantly higher early (23.1 vs. 5.6%; P < 0.001) and late (29.9 vs. 12.8%; P < 0.001) mortality regardless of IRA. In NSTEMI, the inefficacious PCI significantly increased early (19.0% vs. 0.9%; P < 0.001) and late (27.3% vs. 6.3%; P < 0.001) mortality only in patients with Cx-related infarction. Unsuccessful PCI of IRA was an independent risk factor for death in STEMI (HR 1.64; P < 0.05), but not in NSTEMI (P = 0.64). Further analysis showed that whilst unsuccessful PCI of any vessel in STEMI is an independent risk factor for death, in NSTEMI this applies to unsuccessful PCI of Cx only. CONCLUSIONS: The significance of unsuccessful PCI of IRA seems to be different in STEMI and NSTEMI. Unsuccessful PCI is an independent risk factor for death in STEMI regardless of IRA and in NSTEMI with the involvement of Cx.

Prognosis in diabetic patients with acute myocardial infarction treated invasively is related to renal function.

BACKGROUND: The prevalence of diabetes mellitus (DM) and chronic kidney disease (CKD) is rapidly increasing. Both comorbidities are considered significant risk factors for cardiovascular complications. The aim of the study was to evaluate the impact of DM with and without CKD on prognosis in patients with acute myocardial infarction (AMI) treated invasively. MATERIAL/METHODS: This single-center prospective study encompassed 3334 AMI-patients without cardiogenic shock, who were divided into 2 major groups: 999 patients with type 2 DM diagnosed prior to or during index hospitalization, and 2335 non-diabetics. All diabetic patients were divided with respect to their renal status into: diabetics with CKD (DM-CKD; n=264) and without (DM-nCKD; n=735). Short- and long-term outcomes were compared between study groups. Independent predictors of death and composite end-point were selected with multivariate Cox-regression model. RESULTS: Mortality rates were significantly higher in DM group compared to nDM in all observation periods. DM-CKD was associated with excessive total mortality (35.6%) when compared to DM-nCKD (11.6%, P<0.001) and to nDM (9.8%, P<0.001). Mortality and major adverse cardiovascular event rates did not differ significantly between DM-nCKD and nDM groups. Diabetes coexisting with CKD was one of the strongest independent risk factors for death (hazard ratio 1.93; confidence interval 1.79-2.07; P<0.001). CONCLUSIONS: The prognosis in diabetics with AMI is significantly related to renal function. Diabetics without CKD had similar prognosis to non-diabetics. Multivariate analyses showed that unlike diabetes without renal dysfunction, DM-CKD was an independent risk factor for cardiovascular complications and total mortality.

A common variant in low-density lipoprotein receptor-related protein 6 gene (LRP6) is associated with LDL-cholesterol.

OBJECTIVE: A rare mutation in low-density lipoprotein receptor-related protein 6 gene (LRP6) was identified as the primary molecular defect underlying monogenic form of coronary artery disease. We hypothesized that common variants in LRP6 could predispose subjects to elevated LDL-cholesterol (LDL-C). METHODS AND RESULTS: Twelve common (minor allele frequency > or =0.1) single nucleotide polymorphisms in LRP6 were genotyped in 703 individuals from 213 Polish pedigrees (Silesian Cardiovascular Study families). The family-based analysis revealed that the minor allele of rs10845493 clustered with elevated LDL-C in offspring more frequently than expected by chance (P=0.0053). The quantitative analysis restricted to subjects free of lipid-lowering treatment confirmed the association between rs10845493 and age-, sex-, and BMI-adjusted circulating levels of LDL-C in families as well as 2 additional populations - 218 unrelated subjects from Silesian Cardiovascular Study replication panel and 1138 individuals from Young Men Cardiovascular Association cohort (P=0.0268, P=0.0476, and P=0.0472, respectively). In the inverse variance weighted meta-analysis of the 3 populations each extra minor allele copy of rs10845493 was associated with 0.14 mmol/L increase in age-, sex-, and BMI-adjusted LDL-C (SE=0.05, P=0.0038). CONCLUSIONS: Common polymorphism in the gene underlying monogenic form of coronary artery disease impacts on risk of LDL-C elevation.

Immediate ventricular tachycardia after abnormal microvolt T-wave alternans.

Microvolt T-wave alternans (MTWA) is a promising non-invasive method of evaluating repolarization abnormalities. Its presence is strongly related to the occurrence of malignant ventricular tachyarrhythmias and is therefore regarded as a risk marker for sudden cardiac death. Most recent studies have described the usefulness of MTWA in selecting patients who may benefit from a cardioverter-defibrillator. This study presents two cases of patients suffering from ischemic cardiomyopathy, who underwent an MTWA test. Episodes of ventricular tachycardia occurred immediately after the end of the tests, with abnormal results.

[The influence of demographic and clinical parameters on arterial elasticity indices in families with hypertension and coronary artery disease]. / Ocena wplywu czynników demograficznych i klinicznych na wskazniki elastycznosci naczyn tetniczych w rodzinach chorych na nadcisnienie tetnicze i chorobe niedokrwienna serca.

The aim of this study was to assess associations between clinical factors and large (C1) and small (C2) artery elasticity indices. The study was performed in a group consisting of 162 persons: 81 men and 81 women (mean age--43.7 +/- 16.1 years), representing 45 families (88 parents--50 suffering from hypertension, 50 with ischaemic heart disease, 9 type 2 diabetic patients and 74 offsprings--5 with hypertension, 1 with ischaemic heart disease). Mean age in the group of parents was 56.4 +/- 8.3 years, in the group of children--28.7 +/- 8.3 years. Arterial elasticity was assessed using HDI Pulsewave TM CR-2000 machine. Subjects with hypertension had lower C1 than those with normotension (12.2 +/- 4.1 vs 15.0 +/- 3.7, p < 0.00002) and diabetic subjects exhibited lower C1 than non-diabetic controls (11.4 +/- 2.8 vs 14.3 +/- 4, p < 0.04). C2 value was significantly lower in subjects with hypertension (4.1 +/- 2.3 vs 6.7 +/- 2.9, p < 8 x 10(-2)) than in normotensives and patients with coronary artery disease had lower C2 than subjects without heart disease (4.2 +/- 2.1 vs 6.6 +/- 3.1, p < 6 x 10(-6)). C1 correlated inversely with systolic (Rs = -0.54, p < 8 x 10(-14)) and diastolic pressure (r = -0.33, p < 0.003), as well as C2. Filial C1 correlated positively with paternal C1 (Rs = 0.3, p < 0.04). Our data indicate that traditional cardiovascular risk factors correlate with marker of arterial elasticity. Correlation between C1 in fathers and sons suggests the familial predisposition in the group of men.

Cardiac rupture risk estimation in patients with acute myocardial infarction treated with percutaneous coronary intervention.

BACKGROUND: Cardiac rupture (CR) is a common cause of death following acute myocardial infarction (AMI). Despite improvements in AMI treatment, the frequency of CR remains considerable and in most cases leads to death. The aim of the study was to define the independent prognostic CR risk factors of AMI in patients treated with percutaneous coronary intervention (PCI). METHODS: A total of 4,200 AMI patients treated by PCI were studied retrospectively. Two hundred and seventy patients who had died of AMI were examined. In all cases CR was confirmed in post-mortem examination. RESULTS: Cardiac rupture occurred in 49 patients (18.1%). In the CR group, 24.4% patients received thrombolysis and 22.6% in the non-CR group (p = NS). The following characteristics were associated with a higher rate of CR in univariable analysis: age (70.3 +/- 3.2 vs. 65.2 +/- +/- 9.9; p < 0.001), female (75.0% vs. 60.2%; p < 0.001), prior cardiac event and absence of myocardial infarction history (61.2% vs. 40.2%; p < 0.05 and 14.2% vs. 33.4%; p < 0.05), presence of QS complex in first ECG (75.5% vs. 52.0%, p < 0.05) and multiple coronary heart disease (75.5% vs. 61.5%, p < 0.05), and long time from onset of symptoms to thrombolysis and to PCI (8.1 +/- 2.8 vs. 4.7 +/- 2.3 hours, p < 0.001 and 9.0 +/- 5.5 vs. 4.5 +/- 3.2 hours, p < 0.001). In the multivariable analysis, independent predictors of CR were: age (OR: 1.1; 95% CI: 1.02-1.19; p = 0.01); female gender (OR: 0.2; 95% CI: 0.07-0.52; p = 0.001); time from onset of symptoms to PCI (OR: 1.15; 95% CI: 1.07-1.47; p = 0.003). CONCLUSIONS: Old age, female gender and long time from onset of symptoms to AMI treatment (independent of previous fibrinolysis) are independent factors of CR in PCI patients. (Cardiol J 2007; 14: 538-543).

[Erythropoietin administration in diabetic patients]. / Zastosowanie erytropoetyny u chorych na cukrzyce.

This paper presents the role of erythropoietin application in diabetic patients with accompanying renal failure. The main cause of anemia in diabetics are: nephropathy, structural lesions of erythrocyte membrane and blood loss connected with diagnostic and therapeutic actions. There are publications which demonstrate that in patients with diabetes type 1 or 2 with accompanying nephropathy, anemia appears more frequently than in the group of patients with chronic renal failure caused by other factors. It is supposed, that the impaired erythropoietin synthesis in diabetics can be caused by autonomic neuropathy. Erythropoietin administration in case of diabetic nephropathy has a beneficial influence on fat metabolism, immune response and reduction of insuline resistance. Erythropoietin because of reduction of vascular endothelial growth factor synthesis blocks the development of diabetic retinopathy and macroangiopathy. Erythropoietin reduces the risk of the left-ventricular hypertrophy caused by anemia. Very important is that the erythropoietin resistance is lower in diabetics. Scientists who are adverse to erythropoietin administration in patients with diabetic nephropathy maintain, that it can lead to vascular complications and the deterioration of glycemia control.