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Goltz L.,Institute For Klinische Pharmakologie | Bodechtel U.,TU Dresden | Siepmann T.,TU Dresden
Deutsche Medizinische Wochenschrift | Year: 2014

Whereas statins and acetylsalicylic acid (ASA) are considered gold standard for secondary prevention following myocardial infarction or atherotrombotic stroke, there are inconsistent data on the use of these drugs for primary prevention in patients with increased cardiovascular risk. Some meta-analyses indicated that the use of statins and ASA for primary prevention of cardiovascular disease can reduce the risk of cardiovascular events such as ischemic stroke or myocardial infarction. However, the effects of primary prevention with statins and ASA on mortality varied in the data included in these meta-analyses. Therefore the guidelines of the German College of General Practitioners and Family Physicians recommend primary prevention with statins and ASA only in those patients who have a 10-year risk of cardiovascular events which exceeds 20 %. Divergently, primary prevention with ASA is not recommended by the European Society of Cardiology. Observational studies suggested that treatment success of primary prevention with statins and ASA depends on various factors such as adherence to medication and prescription behavior of physicians. This review summarizes the current literature on primary prevention of cardiovascular events with ASA and statins. © 2014 Georg Thieme Verlag KG Stuttgart New York. Source

In the year 2015, many questions regarding the pathophysiology of essential arterial hypertension remain unresolved. Substantial scientific progress has been made in various medical areas aided by novel molecular“omics” techniques. The findings could then be implemented in diagnostic and therapeutic procedures. In the field of hypertension research such methods have been applied in very large cohorts but have contributed less to pathophysiological understanding and clinical management than expected. The findings on the pathophysiological importance of baroreflex mechanisms, natriuretic peptides and osmotically inactive sodium storage discussed in this article all have something in common: all are based on small, carefully conducted human physiological investigations and often challenge current textbook knowledge. Nevertheless, these findings have opened up new research fields and are likely to affect clinical care. © 2015, Springer-Verlag Berlin Heidelberg. Source

Schroder J.,Institute For Klinische Pharmakologie
Deutsche Medizinische Wochenschrift | Year: 2013

Elderly patients often suffer from sleep disturbances. Disorders are mostly caused by medical neurological or psychiatric diseases and multimorbidity. The treatment of the underlying disease should therefore be prioritised. In the symptomatic treatment of insomnia cognitive-behavioural strategies are established. Drug therapy should be considered only if non-pharmacological treatments fail. Most hypnotics have a poor risk-benefit ratio in older patients. In acute severe sleep disturbances prescription of short-acting benzodiazepines and nonbenzodiazepine hypnotics in low doses over a short period of time is acceptable. In patients suffering from chronic insomnia a treatment with sedative antidepressants can be considered keeping in mind possible adverse effects. Studies analysing the current status of care for elderly insomnia patients in Germany are limited. Analyses of health insurance data suggest that especially nursing home patients often use hypnotics. The treatment of sleep disorders in elderly patients must therefore be optimized in practice © Georg Thieme Verlag KG Stuttgart New York. Source

Koenig T.,Rhythmologie und Klinische Elektrophysiologie | Duncker D.,Rhythmologie und Klinische Elektrophysiologie | Hohmann S.,Rhythmologie und Klinische Elektrophysiologie | Schroeder C.,Institute For Klinische Pharmakologie | And 2 more authors.
Herz | Year: 2014

Syncope accounts for approximately 1% of visits to emergency departments. The first diagnostic step is to rule out nonsyncopal conditions as a cause of the transient loss of consciousness. Next, the basic clinical evaluation should identify patients at high risk for potentially life-threatening events. These patients should be admitted and monitored until a diagnosis is made and definitive treatment can be offered. Guided by the basic evaluation findings, specific tests should be performed to prove or rule out the suspected diagnosis. In low-risk patients, this should preferably be done in an outpatient setting. To date, there is no consensus on a structured algorithm for the evaluation of patients with syncope. Therefore, it seems beneficial to formulate an algorithm based on the current guidelines for the management of syncope for use in the clinical setting. © 2014 Urban & Vogel. Source

Bolten W.W.,Abt. Rheumatologie | Kruger K.,Praxiszentrum Rheumatologie | Reiter-Niesert S.,Bundesinstitut For Arzneimittel Und Medizinprodukte Bfarm | Stichtenoth D.O.,Institute For Klinische Pharmakologie
Zeitschrift fur Rheumatologie | Year: 2016

NSAIDs exert their anti-inflammatory and analgesic effects by inhibition of COX‑2, a key enzyme for proinflammatory prostanoid synthesis. Therapy with NSAIDs is limited by their typical gastrointestinal, cardiovascular and renal side effects, which are caused by inhibition of COX‑1 (gastrointestinal toxicity), COX‑2 (cardiovascular side effects) or both COX-isoenzymes (renal side effects). Appropriate prevention strategies should be employed in patients at risk. If gastrointestinal risk factors are present, co-administration of a proton pump inhibitor or misoprostol is recommended; in patients with cardiovascular risk, coxibs, diclofenac and high-dose ibuprofen should be avoided. Furthermore, drug interactions and contraindications should be considered. In patients with renal impairment (GFR < 30 ml/min) all NSAIDs must be avoided. Ulcer anamnesis is a contraindication for traditional NSAIDs. Preexisting cardio- or cerebrovascular diseases are contraindications for coxibs. Treatment decisions should be individually based with a continuous monitoring of the risk – benefit ratio and exploitation of non-pharmacological treatment options. © 2015, Springer-Verlag Berlin Heidelberg. Source

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