Ezetimibe significantly improved lipid and lipoprotein profiles from baseline irrespective of apoE epsilon3/epsilon3 or epsilon4 genotype in Hungarian subjects not at cholesterol goals. Limitations of our study include its open-label nature and small sample population, as well as the facts that patients with the epsilon4 allele were not included and data were not collected on initial cholesterol levels, initial statin doses, cholesterol responses to statins, and the safety and tolerability of ezetimibe. Further randomized controlled studies in larger numbers of people followed for longer intervals are warranted to confirm these findings.

A diabetes mellitus gyakorisága és ezzel együtt népegészségügyi jelentősége is folyamatosan nő. Az utóbbi években tapasztalt javulások ellenére a cardiovascularis betegségek a cukorbetegek morbiditásának és mortalitásának vezető okai. A cukorbetegség fennállása önmagában olyan cardiovascularis veszélyeztetettséget jelent, mintha ismert érbe-tegsége lenne a betegnek. A diabeteses dyslipidaemia jellemzői a magas éhgyomri és postprandialis triglicerid-, alacsony HDL-koleszterin-szint, valamint a kissé emelkedett LDL-koleszterin-szint mellett az atherogen kicsi-sűrű, azaz a small-dense LDL nagy aránya. Az atherogen dyslipidaemiának ezen komponensei nem egymástól független eltérések, hanem egymással szorosan összefüggnek. Az utóbbi évek kutatási eredményei a small-dense LDL és az alacsony HDL káros hatásának elismerése mellett igazolták a trigliceridben gazdag lipoproteinek és azok remnantjainak atherogenitását, továbbá kimutatták, hogy a kulcs a trigliceridben gazdag lipoproteinek májban történő túlter-melése és késleltetett lebontása. Ennek metabolizmusában meghatározó szerepe van a lipoproteinlipáznak, amelynek működését az ApoA5 fokozza, az ApoC3 pedig gátolja. Ez utóbbi funkciócsökkenését okozó mutáció a szívinfarktus kockázatát csökkenti, míg az ApoA5 funkciócsökkenéssel járó mutációja a trigliceridben gazdag lipoproteinszintet 60%-kal emeli és a szívinfarktus kockázatát 2,2-szeresére fokozza. Diabetes mellitus, inzulinrezisztencia, elhízás, metabolikus szindróma esetén az LDL-koleszterinnél a veszélyeztetettségnek jobb markere a non-HDL-koleszterin. Ezt úgy számolhatjuk ki, hogy az összkoleszterinből kivonjuk a HDL-koleszterin értékét. A non-HDL-koleszterin célér-tékeit úgy kapjuk meg, hogy az LDL-koleszterin-célértékekhez 0,8-et hozzáadunk, azaz nagy cardiovascularis kockázat esetén 3,3 mmol/l, igen nagy kockázat fennállásakor 2,6 mmol/l az elérendő szint. Diabeteses dyslipidaemia kezelésében is a statinok az elsőnek választandó gyógyszerek. Ugyanakkor ismert, hogy optimális (vagy célértékre történő) statinterápia esetén is jelentős a residualis(lipid)-kockázat. Ennek mérséklésére a magas trigliceridszint és az alacsony HDL-koleszterin-szint kezelése kézenfekvő, amire a fibrátok adása kedvező hatású lehet. Statin mellé kombinációra a fenofibrát ajánlható. Orv. Hetil., 2016, 157(19), 746-752. Kulcsszavak: diabetes mellitus, cardiovascularis kockázat, diabeteses dyslipidaemia, statin, fibrát Diabetic dyslipidaemia and the atherosclerosisThe incidence and the public health importance of diabetes mellitus are growing continuously. Despite the improvement observed in the latest years, the leading cause of morbidity and mortality of diabetics are cardiovascular diseases. The diagnosis of diabetes mellitus constitutes such a high risk as the known presence of vascular disease. Diabetic dyslipidaemia is characterised by high fasting and postprandial triglyceride levels, low HDL level, and slightly elevated LDL-cholesterol with domination of atherogenic small dense LDL. These are not independent components of the athe...

Acute coronary syndrome (ACS) is a life-threatening condition and the time-period from the onset of symptoms to the patients' arrival into the hospital has crucial importance. The authors investigated retrospectively the patients' decision time (time from the onset of the symptoms to seeking medical help) and the transport time to hospital arrival. In Hungary, it is unique of its kind that the present data can be compared to those obtained in the same area almost three decades ago.One-hundred forty-two patients (106 males and 36 females) were involved in the study, the mean age ± SD was 62.4 ± 11.3 years. The median decision time was 40 min; the median hospital arrival time was 2 h and 13 min. These were significantly shorter than in 1985-1986. These time parameters were influenced neither by gender, age, the number of inhabitants in the patients' city, the patients' education level, the occurrence of any former coronary event in the family and nor by the fact that the type of ACS was myocardial infarction with or without ST segment elevation.During the last two and half decades both the decision and the hospital arrival time decreased significantly (by 39 and 28 %, respectively) probably due to greater knowledge of general practitioners and the better organized ambulance service. Further improvement is needed; this can be expected by consistent education of the patients.

BackgroundVitamin K antagonists, despite their tight therapeutic spectrum and the fear of bleeding complications, were long the most important drugs used in anticoagulant therapy. The aim of this study was to evaluate the quality of anticoagulant therapy and its relation with bleedings in everyday clinical practice.Material/MethodsWe analyzed the data of 272 patients with non-valvular atrial fibrillation treated in our county hospital using retrospective data collection of the last 1008±384 days. The INR (International Normalized Ratio) values and the time in therapeutic range (TTR) were analyzed. We asked patients about bleeding complications and searched the medical records.ResultsThe TTR proved to be 64% and there was no statistically significant difference between that of 252 (92.7%) patients taking acenocoumarol and 20 (7.3%) on warfarin. Analyzing various factors leading to TTR under 70%, we found that none of them have a significant impact. Significantly more bleeding events occurred in the first 3 months after the initiation of anticoagulant therapy and in patients with TTR under 70%, but the latter was not significant after adjustment for factors influencing bleeding (OR 1.607, CI 0.571–4.522, p=0.392).ConclusionsAlthough the present study’s TTR values were similar to those found in the warfarin branch of various large-scale international trials and in real-life settings, further improvement of vitamin K antagonist therapy are necessary. As the possibilities for this are limited, we believe that the new type anticoagulant agents have a place in everyday clinical practice.

Objective: The patients after myocardial infarction could hope for a significant improvement in their life expectancy when complying with the principles of the secondary prevention. Today there is no doubt that the administration of ACE-inhibitors, beta-blockers, aspirin and statins decrease mortality in these patients. Although the clinicians are aware of the guidelines of Evidence Based Medicine, international and Hungarian surveys show that in their everyday application there is still much to improve. Patients and methods: The authors studied the therapy of 200 consecutive patients (115 men and 85 women) who suffered from acute myocardial infarction (either STAMI or NSTAMI) in 1999-2000 at the discharge from their internal medicine department with cardiological profile and 6 months later during outpatient checkup. Having these therapeutic data a special emphasise was given to the same group of drugs and their administration was investigated in patients suffering from acute coronary syndrome with elevated troponin-T levels in the year 2002. Results: In the study of years 1999-2000 at the discharge 175 of 200 patients received ACE-inhibitor (87 %), 121 (60 %) beta-blocker, 180 (90 %) antiplatelet and 102 (51 %) statin therapy. At the time of the control performed 6 months later 85 % of the patients were on ACE-inhibitor, 88 % on beta-blocker, 77 % on aspirin and 47 % on statin therapy. In this high risk population during the 6 months control the LDL-cholesterol goal of 2.5 mmol/l was attained in the 17 % of patients. In the survey performed in 2002 the use of beta-receptor blocker increased to 85 %, antiplatelet drug and statin administration to 95 % and 57 %, respectively. Conclusions: Although the administration of drugs improving life expectancy in the authors' department is comparable with the published Hungarian and international data, effort to the widespread application of the ever growing principles of the Evidence Based Medicine and continuous self-control are essential.