Hana Rosolová

Short to long term mortality of patients hospitalised with heart failure in the Czech Republic—a report from the EuroHeart Failure Survey

The European Society of Cardiology initiated the EuroHeart Failure Survey to obtain more data about the quality of care in patients hospitalised with suspected heart failure (HF). The Czech Republic was 1 of the 24 European Society countries included in the survey. The aim of this report is to extend the original follow‐up period of 12 weeks out to 4 years to assess mortality.

Changes of blood pressure and lipid pattern during a physical training course in hypertensive subjects

Among 77 hypertensive subjects with a previous predominantly sedentary way of life we followed the changes of several cardiovascular and biochemical parameters during a 5-week physical training course. A highly significant drop in both systolic and diastolic blood pressure (BP) was observed in 58 subjects (75%, p less than 0.001). There was a strong negative correlation between initial uricaemia and the diastolic BP decrease (r = -0.382; p less than 0.001). The decrease of systolic as well as diastolic BP correlated positively with the increase of maximum oxygen uptake per kilogram (VO2max/kg) during the intervention (for systolic BP: r = 0.282, p less than 0.05; for diastolic BP: r = 0.286, p less than 0.05). Serum total cholesterol (TC), triglycerides (TG), HDL-cholesterol (HDL-C), uricaemia levels and body mass index (BMI) decreased (p less than 0.01 for uricaemia; p less than 0.001 for the rest), whereas the HDL-C/TC ratio increased significantly (p less than 0.001). These positive changes disappeared already 3-7 months after the intervention except for BMI, TG and uricemia, where the lower levels persisted. Thus, the 5-week intensive physical training had a favourable but short-time effect on BP and lipid pattern in the majority of hypertensives.

Impact of Cardiovascular Risk Factors on Morbidity and Mortality in Czech Middle-Aged Men: Pilsen Longitudinal Study

The impact of biological and life-style characteristics measured during baseline examination on 12-year morbidity and mortality of coronary heart disease (CHD), stroke (STR), and malignancies was investigated in an urban population of 3,540 middle-aged men initially free of clinical disease. The following factors enhanced significantly (at the 5% level) the adjusted relative risk ratios: for total mortality age, smoking, and elevated systolic blood pressure; for CHD age, smoking, elevated systolic blood pressure, serum cholesterol levels, and body mass index, and family history (father or mother). Myocardial infarction was positively associated with age, smoking and elevated serum cholesterol levels. For STR age and elevation of both systolic and diastolic blood pressure were risk factors. The relative risk for all malignancies was enhanced by age and smoking. Regular alcohol consumption was associated with a significantly lower risk for all CHD; however, with only marginal significance for myocardial infarction. Higher education was associated with a significantly lower risk of total mortality, all CHD, and myocardial infarction and a marginally lower risk of STR. A high leisure physical activity was negatively (but not significantly) associated with the risk of all end points.

Cardio-metabolic risk prediction should be superior to cardiovascular risk assessment in primary prevention of cardiovascular diseases.

Cardiovascular atherosclerotic diseases represent the main cause of death in the developed and developing populations. Although major progress has been made in the management of the classical modifiable cardiovascular risk factors, unhealthy lifestyle conduces to an increasing prevalence of overweight, obesity, metabolic disorders, type 2 diabetes mellitus, premature atherosclerosis and cardiovascular diseases. That is why cardio-metabolic risk prediction should be superior in the primary prevention of atherosclerosis and cardiovascular diseases. Up-to-date primary preventive strategies according to the European Guidelines, especially the high risk strategy approach, are being implemented. Individual cardiovascular and better cardio-metabolic risk assessment represents the basic approach in the individualized primary prevention of cardiovascular diseases and type 2 diabetes mellitus. Cardio-metabolic biomarkers, especially high sensitivity C-reactive protein, albuminuria, N-terminal pro-brain natriuretic peptide, and imaging procedures (carotid intima-media thickness measured by ultrasound) could improve the prediction of cardiovascular diseases and type 2 diabetes beyond that using traditional risk factors.

Interaction between angiotensin-converting enzyme genotype and glycaemic control influences lipoprotein levels in Type 2 diabetes mellitus

SummaryAimsTo evaluate the influence of the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism on lipid levels in patients with Type 2 diabetes.Patients and methods109 patients with Type 2 diabetes were included. The patients were not on any lipid-lowering treatment. The groups with different ACE genotypes had similar ages, sex distributions, body mass indices, systolic blood pressures and indices of glycaemic control. ACE gene I/D polymorphism was determined using polymerase chain reaction.ResultsThe mean apolipoprotein B (apoB) level was significantly higher in the group of DD homozygotes compared with the subjects with at least one insertion allele (DD: 1.21±0.25 g/l vs. ID+II: 1.04±0.27 g/l;P=0.007). Significant correlations between glycated haemoglobin (HbA10) and both apoB and cholesterol levels were found (r=0.27;P<0.01). For the apoB, this correlation was highly significant in the DD-genotype subgroup (r=0.54;P<0.01), and was not significant in the subgroup of patients with genotypes ID or II. In the multivariate analysis, HbA10 and the interaction of genotype DD with HbA10 were significant independent predictors of apoB (r2=0.17) and cholesterol levels.ConclusionThe present study showed that the interaction between the DD genotype of angiotensin-converting enzyme and chronic hyperglycaemia (expressed by HbA10 level) is related to higher plasma levels of atherogenic lipoproteins, such as apoB and cholesterol, in patients with Type 2 diabetes.

A multicentre study on unattended automated office blood pressure measurement in treated hypertensive patients

Abstract Aims: Unattended automated office blood pressure (uAutoOBP) may eliminate white-coat effect. In the present study, we studied its relationships to attended office blood pressure (BP) and ambulatory BP monitoring (ABPM). Material and methods: Stable treated hypertensive subjects were examined in four Czech academic hypertension centres. uAutoOBP was measured with the BP Tru device; attended BP was measured six times: three times with auscultatory method (AuscOBP) by the physician followed optionally by three oscillometric measurements (OscOBP). ABPM was performed within one week from the clinical visit. Results: Data on 172 subjects aged 63.7 ± 12.4 years with AuscOBP 127.6 ± 12.1/77.6 ± 10.0 mm Hg are reported. uAutoOBP was by 8.5 ± 9.0/3.0 ± 6.1 mm Hg lower than AuscOBP. The AuscOBP-uAutoOBP difference increased with the AuscOBP level and it did not depend on any other factor. OscOBP differed by 8.6 ± 8.6/1.9 ± 5.7 mm Hg from uAutoOBP. 24-hour mean BP was by 4.2 ± 12.1/3.5 ± 7.8 mm Hg lower than AuscOBP and by 4.3 ± 11.0/0.5 ± 6.9 mm Hg higher than uAutoOBP; the correlation coefficients of 24-hour mean BP with AuscOBP and with uAutoOBP did not differ (p for difference ≥.13). In the lowest BP group (systolic AuscOBP <120 mm Hg or diastolic AuscOBP <70 mm Hg), both AuscOBP and uAutoOBP were lower than 24-hour mean BP, while in the highest BP group (systolic AuscOBP ≥140 mm Hg or diastolic AuscOBP ≥90 mm Hg), they were higher. Conclusions: Compared to uAutoOBP, attended BP measurement gives higher values, both when measured with auscultatory or oscillometric method. Inter-individual variability of AutoOBP – uAuscOBP difference, as well of uAutoOBP – ABPM difference, is large. We did not prove that uAutoOBP would be associated to 24-hour ambulatory BP more closely than attended BP.

Residual cardiovascular risk in patients with stable coronary heart disease over the last 16 years (Czech part of the EUROASPIRE I-IV surveys)

Introduction: Many patients with coronary heart disease (CHD) who achieve target low density lipoprotein cholesterol (LDL-C) values still experience vascular events because of a residual vascular risk due to other risk factors, particularly non-LDL-C dyslipidemia, because of non-adherence to non-pharmacological and pharmacological management. Method and aims: We used simple markers and inexpensive screening tools for metabolic disorders associated with insulin resistance and metabolic syndrome identifying subjects at a high cardiovascular (CV) risk – atherogenic dyslipidemia (triglycerides [TG] ≥2.0 mmol/l and high-density lipoprotein cholesterol [HDL-C] ≤1.0 mmol/l in males and ≤1.2 mmol/l in females), hypertriglyceridemic waist (TG ≥2.0 mmol/l and waist circumference ≥90 cm in males and ≥85 cm in females), atherogenic index of plasma (AIP = log [TG/HDL-C]) and non-HDL-C (non-HDL-C = total cholesterol – HDL-C)]. We focused on the development of these risk factors among patients with established stable CHD over more than the last 16 years. Results: We examined 1 484 patients, 1 152 males (78%) and 332 females (22%) from the Czech parts of EUROASPIRE I–IV (EA I–IV) surveys. In males, TG, HDL-C, and non-HDL-C decreased signifi cantly from EA I to IV (p for trends NS; 0.0001; 0.0001, respectively). In females, there was no change in TG; HDL-C, and non-HDLC decreased signifi cantly (p for trends NS; 0.03; 0.0001, respectively). Atherogenic dyslipidemia prevalence decreased signifi cantly in both sexes (p for trends 0.004 and 0.0012, respectively). Hypertriglyceridemic waist prevalence showed no change in either sex. There were no signifi cant changes in AIP risk strata in either sex. About 30–40% of males and 24–30% of females had their AIP in the high-risk strata, which tended to increase in males. The prevalence of type 2 diabetes (T2DM) and waist circumference increased signifi cantly from EAI to IV (from 23% to 48%, and from 98 cm to 105 cm, respectively; both p for trend <0.0001). The prevalence of all above mentioned residual vascular risk markers was higher in patients with T2DM and impaired fasting glucose than in those with normal fasting glucose in both sexes. Conclusion: Despite the increase in T2DM prevalence and waist circumference from EA I to IV, hypertriglyceridemic waist prevalence showed no change and atherogenic dyslipidemia prevalence decreased signifi cantly in both sexes, because not all obese patients are insulin-resistant and not all patients with glucose metabolism disorders present all characteristics of metabolic syndrome. Simple markers of the atherogenic phenotype, especially AIP, should be used in CV risk assessment. 132_138_Puvodni sdeleni Nussbaumerova.indd 133 7.4.2014 11:12:00 134 Reziduální KV riziko nemocných se stabilní ICHS byly TG ≤ 4,5 mmol/l. Nízký HDL-C byl defi nován jako ≤ 1,0 mmol/l u mužů a ≤ 1,2 mmol/l u žen. Zvýšené TG byly defi novány jako ≥ 2,0 mmol/l. Aterogenní dyslipidemie byla defi nována jako současná přítomnost obou výše uvedených parametrů. Non-HDL-C byl vypočten jako non-HDL-C = TC – HDL-C (mmol/l). Cílové hodnoty non-HDL-C u nemocných s ICHS jsou < 2,6 mmol/l [14]. Hypertriglyceridemický pas byl defi nován jako současná přítomnost TG ≥ 2,0 mmol/l a obvodu pasu ≥ 90 cm u mužů a ≥ 85 cm u žen [11,12]. Obvod pasu byl měřen v polovině vzdálenosti mezi nejdistálnějším bodem žeberního oblouku a spina iliaca anterior superior v lehkém výdechu [13]. Aterogenní index plazmy (AIP = log [TG/HDL-C]) je založen na laboratorních nálezech týkajících se mechanismu regulace velikosti lipoproteinových částic. Nemocní se stabilní ICHS byly rozděleni do tří rizikových kategorií dle hodnot AIP: nízké riziko –0,3 až –0,10, střední riziko 0,11 až 0,24, a vysoké riziko > 0,24 [15,16]; vzorec pro jednoduchý výpočet AIP je dostupný online [17]. Statistické metody užité k analýze výsledků byly Mannův-Whitneyho test, mnohočetná logistická regrese a Kruskalova-Wallisova analýza variance ANOVA.

The New Editorial Board: 1991-1996

The New Editorial Board: 1991-1996 Cardiology was first published in 1937; the original editors were Drs. Bruno Kirsch of Cologne and W. Löffler of Zurich. The journal was originally named Cardiologia International Archives of Cardiology. In 1970, the name of the journal was changed to Cardiology. The Editorial Board at the time the journal was founded consisted of 24 distinguished cardiologists from Europe, North and South America, and Asia. The United States had 5 members including Paul D. White and Frank N. Wilson; Switzerland had 3 members, the UK and Czechoslovakia 2. The remaining 14 members came from the Netherlands, Portugal, Rumania, France, Germany, Sweden, Denmark, Austria, Mexico, and Japan. The 3 eastern European members are of even greater interest given current political changes in that region. More than half the articles in the first two volumes were in German, a quarter were in French, 15% were in Italian, and only 5% were in English. By 1960, the majority of the articles were in English, although French and German manuscripts were still being published. In 1970, when the journal took its present name, English became the sole language of the publication. Contributions in those first two volumes (1937-1938) came from the Netherlands, Italy, Germany, Denmark, France, Switzerland, and the USA. Each article ended with summaries in French, German, English, and Italian. There were no editorials and only occasional book reviews. Slightly more than one-third of the articles dealt with laboratory investigations in animals. Most studies were observational rather than experimental. It is interesting to review the topics covered in the first two volumes of Cardiologia. A number of animal studies were published including one of particular merit on the circulatory effects of intravenous epinephrine and adrenal cortical hormones. Clinical studies of note included work dealing with ventricular premature beats recorded by electrocardiography, congenital heart block, pathological observations on the etiology of atherosclerosis, and the application of cardiac output determinations to clinical problems. Thus, many of the topics which interest us today were already being considered in 1937 and 1938. Modern cardiology was already prefigured at that time. The new Editor and Editorial Board are honored to be part of a scholarly enterprise that is more than 50 years old. On behalf of the publisher and the members of the new Board, I would like to take a few minutes of 2 The New Editorial Board: 1991-1996