Hradec J.,III. Interni Klinika 1. LF UK a VFN Prague
Vnitrni Lekarstvi | Year: 2014
Heart failure occurs in diabetic patients and vice versa, among patients with heart failure is high prevalence of diabetes mellitus. Treatment of heart failure in diabetics is not substantially different from the treatment of heart failure in non-diabetic patients. It is based on ACE-inhibitors, beta-blockers and mineralocorticoid receptor blockers. In advanced heart failure the treatment with various devices reaches importance, for example biventricular pacing for cardiac resynchronization. Recently, it has been discussed the question of long-term cardiovascular safety of hypoglycaemic drugs. Older anti-diabetic agents such as insulin, metformin, and sulfonylurea are considered to be cardiovascular safe. However, rosiglitazone from thiazolidinedione class increases incidence of cardiovascular events, resulting in cancellation of its registration in Europe and its considerably limited use in the United States. Therefore, cardiovascular safety is tested very carefully in clinical trials in new anti-diabetic agents that affect incretin system. Recently, saxagliptin has shown to increase incidence of heart failure in diabetic patients.
Brat J.,Vim |
Vrablik M.,III. Interni Klinika 1. LF UK a VFN Prague |
Herber O.,Ustav Vseobecneho Lekarstvl I. LF UK Prague
Vnitrni Lekarstvi | Year: 2015
Europe is a region, which is most severely affected by non-communicable diseases. Cardiovascular disease is the leading cause of disability and death. Complex interactions between diet, lifestyle, and lipoprotein metabolism significantly contribute to the development of atherosclerosis and its complications. Role of diet in prevention of coronary heart disease becomes sometime underestimated in comparison with pharmacological treatment. Coronary heart disease (CHD) mortality has declined substantially in the Czech Republic in the last decade of the 20th century. Significant and positive dietary changes, mainly reduction of saturated fatty acids intake and its replacement by polyunsaturated fatty acids, contributed to decline of the average serum cholesterol level in population. Fall in CHD mortality was attributable to reduction in this major cardiovascular risk factor and not driven by pharmacological intervention. The Czech Republic is not the only country where similar trends have been recorded. Improvements in dietary habits seem to be one of the most important strategies in cardiovascular disease prevention.