Slaven Kokić

The impact of hormone replacement therapy on metabolic syndrome components in perimenopausal women

Hormone replacement therapy (HRT) is in use for more than a half of century, but the question of indications and ideal candidates for HRT remains unclear. Postmenopausal women are a population with the increasing risks for cardiovascular diseases which are the main cause of death in this group. Decline in oestrogen concentrations is linked to a number of changes in peri and postmenopause: increased total cholesterol, triglycerides, and low density lipoprotein, increased insulin resistance and impaired fibrinolysis. These changes are the main components of metabolic syndrome, the epidemic of the modern age. HRT is currently recommended as the gold standard for the management of vasomotor symptoms, but the benefit of HRT on components of metabolic syndrome and risk for cardiovascular events is still uncertain. In the initial reports from the Womens Health Initiative trial (WHI), overall health risks exceeded benefits in the cohort taking combined estrogen-progestin trial. Observational study in postmenopausal women, some meta-analyses and subsequent analyses of WHI had suggested that the timing of exposure to postmenopausal estrogen therapy may be an important factor in determining subsequent cardiovascular risk. It seems that the early therapy onset is a key factor in accomplishing positive results, but there are almost no surveys regarding the effects on the metabolic syndrome components in perimenopausal women. We hypothesized that the early, low dosage HRT in healthy perimenopausal women would have beneficial effects on the compounds of metabolic syndrome and could decrease the risk of cardiovascular events. Beneficial effect of HRT on cardiovascular diseases is due to the maintained integrity and functional status of the endothelium in younger women. We are aware of the fact that further studies are necessary to test the effects of different doses and routes of administration of HRT on cardiovascular outcomes.

Transcranial Doppler ultrasound assessment of intracranial hemodynamics in patients with type 2 diabetes mellitus

BACKGROUND Diabetics have a 3-fold risk for cardiovascular diseases compared with non-diabetics. This study was designed to evaluate cerebral hemodynamic changes related to type 2 diabetes mellitus (DM) with transcranial Doppler ultrasonography (TCD). TCD is a highly sensitive and specific method of quick bedside assessment of cerebrovascular circulation hemodynamics. PATIENTS AND METHODS In a prospective study, we compared a group of 100 patients with the diagnosis of type 2 diabetes mellitus (aged 48 to 67 years) and an age- and sex-matched control group of 100 healthy subjects without diabetes mellitus. We measured flow velocities (Vm) and the Gosling pulsatility index (PI) of the middle cerebral artery (MCA). RESULTS The rate of TCD abnormalities was significantly higher in diabetic patients than in healthy control subjects (55% vs. 11%, P<0.05). The PI was significantly higher in diabetic patients than in healthy controls (P<0.001). Atherosclerotic changes were found in 34.0% and 71.4% of patients suffering from diabetes for <5 and ≥5 years, respectively. CONCLUSION This study suggests that TCD is a useful marker for the detection of diabetic cerebrovascular changes. The duration and type of diabetes were found to have an impact on the development of pathologic cerebrovascular changes.

Prediabetes awareness among Southeastern European physicians

Prediabetes (PD) represents a transitional state where the glucose levels are higher than normal, but not enough for diabetes mellitus diagnosis. As there is a growing number of the population with PD, its early detection and treatment could prevent the development of diabetes mellitus and its complications. We aimed to assess the overall knowledge of PD among medical professionals of different varieties.