Hlavní téma – metabolický syndrom

prof. MUDr. David Karásek, Ph.D.

Vnitr Lek 2024, 70(2):71  

Treatment of dyslipidemia in metabolic syndrome

Michal Vrablík

Vnitr Lek 2024, 70(2):76-82 | DOI: 10.36290/vnl.2024.017  

Metabolic syndrome continues to represent one of the most common clinical situations associated with increased cardiometabolic risk in the Czech Republic. Dyslipidemia found in patients with metabolic syndrome is the main carrier of increased risk of atherothrombotic complications. Non-pharmacological measures improve all other components of the metabolic syndrome in addition to dyslipidemia. Their enforcement is difficult and pharmacotherapy should not be postponed, especially in persons at high and very high cardiovascular risk. Hypolipidemic treatment in people with metabolic syndrome should be based on a statin, possibly in combination with ezetimibe....

Arterial hypertension in metabolic syndrome, 2024

Barbora Nussbaumerová, Hana Rosolová

Vnitr Lek 2024, 70(2):84-90 | DOI: 10.36290/vnl.2024.018  

Metabolic syndrome is a cluster of cardiometabolic risk factors. The diagnosis includes elevated blood pressure (BP), elevated plasma glucose, dyslipidemia (elevated triglycerides and low HDL-cholesterol) and abdominal overweight or obesity. Lifestyle changes are essential in the treatment of MS. Hypertension is defined as office systolic BP values ≥ 140 mm Hg and/or diastolic BP values ≥ 90 mm Hg which are also borderline values to iniciate drug treatment. Lowering blood pressure can substantially reduce premature morbidity and mortality. Provided that the treatment is well tolerated, treated BP values should be targeted to 130/80 mm Hg...

Metabolic effects of glyphlozines

Michal Krčma

Vnitr Lek 2024, 70(2):91-96 | DOI: 10.36290/vnl.2024.019  

Gliflozins, or SGLT-2 inhibitors, are a relatively new class of drugs, first introduced as antidiabetic agents. The observed positive effects on the cardiovascular system and renal function later led to a widening of the spectrum of indications. The article describes the different metabolic pathways of action, discusses the side effects of treatment as well as the management of specific medical situations. It provides an overview of health insurance reimbursements at the end of the text.

Incretins and the metabolic syndrome

David Karásek

Vnitr Lek 2024, 70(2):97-101 | DOI: 10.36290/vnl.2024.020  

Metabolic syndrome is characterized by the accumulation of adverse cardio-metabolic risk factors. Non-pharmacological measures are an important part of its treatment, but many patients cannot follow them, or the measures are insufficiently effective. Pharmacological treatment usually consists in the intervention of individual components of the metabolic syndrome. There is increasing evidence that incretin mimetics, which were originally developed for the treatment of type 2 diabetes, have the potential to beneficially affect not only hyperglycemia or obesity, but also dyslipidemia and elevated blood pressure. There is also evidence that some agonists...

How to approach arterial hypertension in adolescents and young adults?

Jitka Mlíková Seidlerová

Vnitr Lek 2024, 70(2):126-130 | DOI: 10.36290/vnl.2024.025  

Arterial hypertension is observed less frequently in adolescents and young adults than in older persons. Although the absolute cardiovascular risk in this age group is low, untreated hypertension is a source of organ damage development and health complications later in life. Therefore, diagnosis and early initiation of treatment is an important part of the management of this population. The cornerstone of diagnosis is the measurement of blood pressure in a healthcare facility and using out-of-office methods of blood pressure measurement. In indicated cases, secondary hypertension must be excluded. We always search for and intervene other cardiovascular...

Prevention of the development of advanced chronic heart failure - pharmacotherapy options

Monika Špinarová, Jiří Vítovec, Lenka Špinarová

Vnitr Lek 2024, 70(2):102-106 | DOI: 10.36290/vnl.2024.021  

The treatment of chronic heart failure is always complex and includes both pharmacological and non-pharmacological procedures. However, the disease progresses to the end-stage of advanced heart failure in many patients, which is characterized by the persistence of symptoms despite maximal therapy. The basis of the treatment of patients with heart failure with reduced ejection fraction (HFrEF) are 4 pillars of drug groups: Angiotensin Receptor-Neprilysin Inhibitor (ARNI)/ Angiotensin-Converting Enzyme Inhibitors (ACEi), Beta blockers (BB), Mineralocorticoid receptor antagonist (MRA) and Sodium-glucose cotransporter-2 inhibitors (SGLT2i), which have...

Resistant hypertension

Jan Filipovský

Vnitr Lek 2024, 70(2):108-112 | DOI: 10.36290/vnl.2024.022  

Resistant hypertension is defined as blood pressure (BP) ≥ 140/90 mmHg despite administration of at least three antihypertensive drugs including diuretics in maximum tolerated doses. Pseudoresistance due to bad adherence to treatment is very common. Ambulatory BP monitoring should be done should be performed as up to one third of patients has ambulatory BP within normal limits. Secondary causes of hypertension should be excluded. Resistance on treatment is common in patients with renal parenchymatous hypertension. The diagnosis of primary aldosteronism may be more difficult and may occur also in young patients with hypertension. Other causes...

Novel insights into pathophysiology and management of hypertrophic cardiomyopathy

Miloš Kubánek

Vnitr Lek 2024, 70(2):113-119 | DOI: 10.36290/vnl.2024.023  

We aimed to summarize the current knowledge regarding the pathophysiology and management of hypertrophic cardiomyopathy (HCM). Genetic aetiology of HCM can be traced in approximately 30-50% of probands. The predominant pathogenetic mechanisms of genetic HCM seem to be hypercontractility of sarcomere and its impaired relaxation due to depletion of super-relaxed isoform of cardiac myosin heavy chain. These processes may lead to an increased energetic consumption and possibly to progression of left ventricular (LV) hypertrophy. Inhibition of cardiac myosin ATPase corrects hypercontractility of sarcomere and its impaired relaxation both in tissue and animal...

Pharmacological treatment of osteoporosis and prevention of fractures: recommendations for clinical practice

Vít Zikán

Vnitr Lek 2024, 70(2):E7-E23 | DOI: 10.36290/vnl.2024.028  

The clinical significance of osteoporosis lies in the low-trauma fractures that arise. Fractures lead to increased morbidity, excess mortality, decreased quality of life and loss of autonomy. Management of osteoporosis involves assessing risk factors for fracture, reducing modifiable risk factors through dietary and lifestyle changes, and the use of pharmacologic therapy for patients at significant risk of fractures. Osteoporosis is a chronic condition and therefore needs a long-term management plan with a personalized approach to treatment. Current medications build bone and/or decrease bone breakdown and reduce incident fractures. In individuals...

Antibiotic treatment of patients hypersensitive to penicillin and β-lactam antibiotics

Martin Sučík, Róbert Rosoľanka, Dušan Krkoška, Katarína Šimeková

Vnitr Lek 2024, 70(2):E24-E31 | DOI: 10.36290/vnl.2024.029  

Presumed or confirmed hypersensitivity to penicillins is a common problem in clinical practice. Knowledge about the nature of cross-reactivity of the immune system to various β-lactam antibiotics has increased considerably over the years. The original notion of a high degree of cross-reactivity between the major groups of β-lactam antibiotics was based on the presence of a common β-lactam ring in their molecule. However, the conclusions of recent clinical observations and studies suggest that the match or similarity of the side chains bound to the β-lactam ring plays a dominant role in the development of cross-reactivity between...

Focal segmental glomerulosclerosis

Silvie Rajnochová Bloudíčková, Dana Thomasová

Vnitr Lek 2024, 70(2):E32-E36 | DOI: 10.36290/vnl.2024.030  

Focal segmental glomerulosclerosis, FSGS, is a progressive glomerular disease of different ethiology that leads in almost 50 % of patients to end stage renal failure. FSGS is caused by damage of podocytes, histologically characterized by partial scarring of glomeruli, clinically by nephrotic-range proteinuria or nephrotic syndrome and unsatisfactory therapeutic response. Kidney transplantation in FSGS patients is associated with high risk of disease recurrence and worse long-term outcomes. Early treatment is essential for the patient's prognosis, which varies between different forms of FSGS (primary, secondary, genetic).

Cutting-edge technology in medicine: the use of continuous glucose monitoring in reimbursed carein the Czech Republic in 2014-2021: data from the National Registry of Covered Health Services

Jan Brož, Jana Urbanová, Martina Nováková, Klára Benešová, Jiří Jarkovský, Ladislav Dušek, Dominik Foltán, Matúš Marec, Lukáš Rozsíval, Denisa Janíčková Žďárská, Milan Kvapil

Vnitr Lek 2024, 70(2):E3-E6 | DOI: 10.36290/vnl.2024.027  

Continuous glucose monitoring (CGM) is currently the most effective way to control glucose excursions in patients with diabetes mellitus (DM). In the Czech Republic, health insurance companies have covered enough CGM for patients with type 1 diabetes cover the entire year from December 2019. Based on data obtained from the National Registry of Covered Health Services - NRHZS), an estimated 38% of patients used one of the CGM systems in 2021, with approximately 2/3 of patients using intermittent scan monitoring (isCGM). The analysis showed differences in CGM use between different age groups of diabetic patients and also large differences between regions,...

Suspicion of a hypervitaminosis A during acitretin therapy

Markéta Kobzová, Pavel Polák

Vnitr Lek 2024, 70(2):120-125 | DOI: 10.36290/vnl.2024.024  

The authors present a clinical case of a 90 years old woman treated with acitretin for psoriasis during past two years, in whom develloped spontaneously haemorrhagic blisters on extremities, on oral mucosal surfaces and large subcutaneous hematomas. In the differential diagnostic work-up an allergy to co-trimoxazole, plazmocellular neoplasia, amyloidosis and bacterial endocarditis were suspected. Both microscopic evaluation as microbial cultivation of the aspirated hemorrhagic fluid were concluded as contamination. There were no signs of paraproteinemia in serum immunoelektrophoresis study. Extended medical history revealed till months persisting xerophthlamia,...

What´s new in Infectology?

Petr Husa, Svatava Snopková, Petr Husa ml.

Vnitr Lek 2024, 70(2):131-137 | DOI: 10.36290/vnl.2024.026  

Infectious diseases are still a major health, social and economic problem in the 21st century. New treatment options for HIV and viral hepatitis D, the increasing incidence of viral hepatitis E and alveococcosis in the Czech Republic are discussed. In all cases, these are highly topical issues that are important in the Czech Republic and internationally. Long-acting slow effective release antiretroviral therapy (LASER ART) represents the most advanced form of modification of antiretroviral therapy (ART). It has been available in the Czech Republic since February 2023. According to clinical trials, 90-98 % of patients prefer a long-term regimen. Bulevirtide...