[Questions in diabetology to be elucidated]. / Diabetológiai kérdojelek.

Despite advances in the management of cardiovascular diseases, the incidence of cardiovascular diseases is increasing both in developed and developing world. This phenomenon is associated with the worldwide pandemic of obesity and type 2 diabetes; both are related to the life style of urbanization. The association between life conduct of civilization and chronic stress resulting in augmentation of cardiovascular risk is detailed. Therapeutic policy practiced nowadays (polypill administration, achieving target values) in order to reduce cardiovascular risk is criticized. Primary causal role of chronic stress and life style, and secondary resultant nature of cardiovascular risk factors are stressed out in the pathogenesis of increased cardiovascular risk; therefore, limited value of an approach focusing on the management of cardiovascular risk factors, instead of targeting the primary cause, i.e. chronic stress and life conduct is emphasized. A short account is given about the similarities and dissimilarities in the pathogenesis of macro- and microangiopathy. The primary causal role of chronic stress in fetal and adult diabetes, furthermore possible triggers evoking chronic stress is discussed. Supportive experimental and clinical data are reported about the nature of basic metabolic dysregulation (dysmetabolism) in the pathogenesis of metabolic syndrome and type 2 diabetes. Besides the well documented significance of ischemic clinical manifestations of diabetes, the role of non-ischemic diabetic cardiomyopathy as an independent risk factor in evoking the total burden of cardiovascular risk in diabetes is emphasized. In reducing the cardiovascular risk in diabetics the management of high blood pressure and dyslipidemia is more effective compared to that of hyperglycemia. Besides managing cardiovascular risk factors, the successful treatment of dysmetabolism is importantly needed to eliminate the total excessive cardiovascular risk in diabetes. In order to achieve this goal the potential role of metabolic promoters is stressed out.

Acquired angioedema associated with primary antiphospholipid syndrome in a patient with antithrombin III deficiency.

Acquired angioedema (AAE) due to the functional deficiency of the C1 inhibitor (C1-INH) is a rare disease characterized by recurrent bouts of edema that involve subcutaneous tissues, the larynx or the gastrointestinal tract. In the present paper, we report the case of a male patient with symptoms of AAE and recurrent deep venous and arterial thrombosis. As a trigger of AAE in the present patient, we revealed primary antiphospholipid syndrome accompanied by antithrombin III deficiency, along with malignancy in the history, and angiotensin-converting enzyme inhibitor therapy. Although anti-C1-INH titers (type I AAE) were normal initially, we observed a sharp increase in anti-C1-INH titers (suggestive of type II AAE) during follow-up. It seems that thrombosis might worsen angioedematous attacks in functional C1-INH deficiency. Thrombophilia should be considered a provoking factor of AAE and should be carefully sought for in these patients, as the key to successful management of AAE is the effective treatment of the underlying disease.

[Role of blood glucose in prediction of cardiovascular risk]. / A vércukor szerepe a cardiovascularis kockázat elorejelzésében.

Increased cardiovascular risk in diabetes mellitus has been well-documented. In contrast, it is not widely known, that the relation between degree of hyperglycemia and mortality of diabetics or nondiabetics with acute coronary syndromes (ACS) shows a positive correlation. Insulin treatment significantly improves survival of patients with both ACS and septicemia. New onset diabetes or impaired glucose tolerance can be detected in significant proportion of patients with AMI or coronary artery disease. New onset disturbance of carbohydrate metabolism has a powerful negative influence on clinical prognosis, therefore it's early diagnosis is considered an important new challenge for clinicians. The authors discuss prognostic significance of hyperglycemia-induced macroangiopathy, postprandial blood glucose, and concomitant metabolic state, respectively, furthermore potential therapeutic role of insulin in treatment of ischemic, reperfusional, and toxic metabolic disturbances.