Wiktoria Leśniak

Effects of megestrol acetate in patients with cancer anorexia-cachexia syndrome--a systematic review and meta-analysis.

INTRODUCTION Anorexia-cachexia syndrome (ACS) often occurs in patients with advanced cancer. OBJECTIVES To review the effect of megestrol acetate (MA) in patients with ACS. PATIENTS AND METHODS To identify eligible studies, systematic review by Lopez et al. (2004) was used, electronic databases (MEDLINE, EMBASE and CENTRAL) were searched and reference lists of included studies were reviewed. The studies were included in the review if they were randomized, enrolled patients with non-hormone-sensitive cancer and ACS and assessed the effects of MA compared with placebo, other drugs or different doses of MA. RESULTS The study population is characterized by high mortality and progressive weight loss irrespective of the treatment. Compared to placebo, the effect of MA on survival is similar, but MA increases appetite (number needed to treat [NNT]: 3) and leads to weight gain (NNT: 8) in more patients. The data on other aspects of the quality of life are limited. The comparison of MA and glucocorticosteroids showed no statistical difference in their effect on appetite and weight. CONCLUSIONS Compared to placebo, MA reduces the symptoms of ACS, with no effect on survival. The beneficial effect of MA on the overall quality of life has not been confirmed. In identified studies the effect of MA and glucocorticosteroids on anorexia and cachexia is similar. The estimation of the treatment utility in ACS depends on the weight attributed to discomfort caused by symptoms, adverse effects of the drugs and the treatment cost. Because of the low quality of the included studies a new randomized controlled trial is needed for valid assessment of the effects of MA.

Cardiovascular risk management in type 2 diabetes of more than 10-year duration: Results of Polish ARETAEUS2-Grupa Study

BACKGROUND ARETAEUS 1 study showed that a great majority of patients with type 2 diabetes mellitus (T2DM) of short duration did not meet all of the treatment goals. Since then the treatment goals in T2DM have been changed. The aim of the ARETAEUS 2-Grupa Study was to assess cardiovascular (CV) risk management and meeting treatment goals in the population of T2DM of more than 10-year duration. METHODS ARETAEUS2-Grupa was a cross-sectional questionnaire-based study conducted in Poland in 2012. Randomly selected physicians recruited 1,740 patients with T2DM diagnosed more than 10 years before the study. RESULTS Lipid treatment goals were met respectively: for total cholesterol in 34.5% of all patients, triglycerides in 53.8%, low density lipoprotein cholesterol (LDL-C) in 26.5% and high density lipoprotein cholesterol (HDL-C) in 38.2%. Most of patients with and without coronary artery disease were receiving aspirin (90.3% and 60%, respectively) and statins (84.4% and 67.7%, respectively). The current blood pressure (BP) goal (140/90 mm Hg) was met in 43.5% of patients and the previous goal (< 130/80 mm Hg) in 12.4%. The patients were mainly treated with ≥ 3 antihypertensive drugs. All treatment goals (for HbA1c, BP and LDL-C) were reached only by 8.2% of patients, any two goals by 26.3% of patients, one goal by 39.8% of patients, none by 25.6% of patients. CONCLUSIONS The new less restrictive treatment goals are reached more frequently but still much is to be done in the field of clinical practice guidelines implementation and CV prevention in T2DM population.

Relationship between gender and clinical characteristics, associated factors and hypertension treatment in patients with resistant hypertension.

BACKGROUND AND AIM Recent meta-analyses indicate that the pooled prevalence of resistant hypertension (RHT) barely differs between the sexes. However, differences between women and men with RHT in patient characteristics, associated factors, and hypertension (HT) management are still not well-described. METHODS In the cross-sectional questionnaire-based observational study we included 7306 hypertensive females and 5069 hypertensive males, ≥ 18 years old, and treated for at least 12 months with antihypertensive drugs. We defined HT control as blood pressure (BP) levels both < 140 mm Hg/< 90 mm Hg. Patients were divided into three groups: controlled HT, uncontrolled HT (not fulfilling the criteria of RHT), and RHT (uncontrolled HT despite using three antihypertensive drugs including diuretic). Cardiovascular (CV) risk was evaluated according to 2013 ESH/ESC guidelines. RESULTS There were no differences in the rates of controlled HT (47.6% vs. 47.0%), uncontrolled HT (27.3% vs. 28.8%), and RHT (25.1% vs. 24.2%) between women and men, respectively (p = 0.17). Among patients with RHT, women were older than men and had lower diastolic BP and estimated glomerular filtration rate (eGFR) as well as higher pulse pressure (PP). Cerebro-vascular diseases (16.9% vs. 14.3%; p = 0.062), abdominal obesity, and metabolic syndrome (MS, 70.5% vs. 60.1%; p < 0.001) were more frequent among women than men with RHT. Women with RHT had higher rate of high/very high added CV risk in comparison to men. In a multivariate model higher PP, presence of MS, CV disease, and eGFR < 60 mL/min/1.73 m² were related to the presence of RHT both in males and females. In women RHT was also related to abdominal obesity, cerebro-vascular diseases, and diseases causing disability. In men, RHT was additionally related to diseases requiring treatment with non-steroidal anti-inflammatory drugs. CONCLUSIONS Although there were no differences in the rate of RHT between women and men, we identified gender-related differences in CV risk profiles in RHT patients and in factors related with the presence of RHT. When divided into age groups, RHT was less frequent in women aged less than 40 years and aged between 40 and 65 years, and among patients 65 years and older there was a tendency towards a higher rate of HT in women.

Trends for beta-blockers use in a large cohort of Polish hypertensive patients — Pol-Fokus Study

Background Beta-blockers remain one of the most frequently prescribed antihypertensive drug classes. The aim of the analysis was to evaluate characteristics of patients treated with beta-blockers and factors associated with the treatment of beta-blockers. Material and methods We analysed the data from the large cross-sectional study evaluating 12,375 patients treated for hypertension for at least one year. Results Overall, 7080 patients (57.2% of the whole group) were treated with beta-blockers. The rate of use of beta-blockers was higher in patients with diabetes (62.9 vs 55.6%), coronary artery disease (72.2 vs 46.4%), previous myocardial infarction (82.3 vs 54.1%), heart failure (73.1 vs 53.3%) and arrhythmias (73.1 vs 51.1%) than in patients without those conditions (all comparisons p < 0.001). Beta-blockers were used less frequently among patients with asthma/COPD than without asthma/COPD (54.0 vs 58.0%; p = 0.017). In patients aged 40 years and less, the compelling indications for these agents were found only in 21.7% of patients. In patients aged 40–65 years, none of compelling indications was found in 41.3% of patients. In patients 65 years or more, the most frequent compelling indications were coronary artery disease, previous myocardial infarction and heart failure, which were present in 70.1% of patients. Conclusions High utilization rate of beta-blockers in patients with hypertension, only second to renin-angiotensin blockers, has been shown. In middle age and, especially, in older patients it might reflect high cardiovascular burden of those patients, including coexistence of established cardiac disease. In younger patients beta-blockers are used more frequently with none of the compelling indications present.