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Snežana Jovičić

Biohemijski Aspekti, Laboratorijska Dijagnoza I Praćenje Povišene Koncentracije Holesterola: Preporuke NCEP ATP III

Treći izveštaj ekspertske grupe o detekciji, evaluaciji i tretmanu povišene koncentracije holesterola u odraslih (Adult Treatment Panel III, ATP III) predstavlja ažuriran klinički vodič Nacionalnog programa edukacije o holesterolu (National Cholesterol Education Program, NCEP), o određivanju holesterola i zbrinjavanju osoba s povišenom koncentracijom holesterola u serumu. Pored toga što preporučuje intenzivan tretman pacijenata sa koronarnom srčanom bolešću (coronary heart disease/CHD), važna karakteristika ATP III je težište na primarnoj prevenciji kod osoba sa više prisutnih faktora rizika. ATP III nastavlja da identifikuje povišene koncentracije LDL holesterola kao primarni cilj terapije za snižavanje holesterola. Osnovni princip prevencije je da se intenzitet terapije prilagođava apsolutnom riziku za CHD svake osobe pojedinačno. Procena rizika podrazumeva određivanje LDL holesterola u sklopu analize lipoproteina i identifikaciju pratećih determinanti rizika (prisustvo ili odsustvo CHD, drugih kliničkih oblika aterosklerotske bolesti i dijabetesa, pušenje, hipertenzija, niska koncentracija HDL holesterola, porodična anamneza prevremene pojave CHD, starost). U kategoriji najvišeg rizika nalaze se osobe sa CHD i CHD ekvivalentima rizika, čiji je apsolutni rizik od pojave srčane smrti ili nefatalnog infarkta miokarda u narednih 10 godina ≥20%. Drugu kategoriju čine osobe sa dva ili više faktora rizika kod kojih je 10-godišnji rizik <20%. Apsolutni rizik se procenjuje na osnovu Framingham rizik skora. U trećoj kategoriji su osobe sa jednim ili nijednim faktorom rizika. Definisane su preporučene koncentracije LDL holesterola za svaku kategoriju i postižu se korekcijom ishrane i/ili farmakoterapijom. Evropske preporuke za prevenciju kardiovaskularne bolesti (cardiovascular disease, CVD) u kliničkoj praksi preporučuju upotrebu SCO-RE (Systematic COronary Risk Evaluation) tablica za procenu rizika za pojavu CVD, koje podrazumevaju apsolutnu verovatnoću za fatalan ishod CVD u toku 10 godina. Cilj ovog rada je predstavljanje delova NCEP ATP III i evropskih preporuka značajnih za njihovu implementaciju u laboratorijsku praksu.

Open access

Nevena Eremić and Mirjana Đerić

Evaluation of Coronary Risk Score Applications in 10-Year Coronary Heart Risk Estimation

Atherosclerosis is a multifactorial disease with risk factors that have multiple effects. In the identification and treatment of asymptomatic individuals at high risk for developing coronary heart disease (CHD) different risk scoring schemes are used in everyday routine. The aim of this study was to compare SCORE recommended for our country with two other most frequently used risk schemes for 10-year CHD risk evaluation: Framingham and PROCAM as well as their modifications. From 220 examined subjects of both sexes, who were treated mainly for lipid metabolism disorder at the Dispensary for Atherosclerosis Prevention, Centre for Laboratory Medicine, Clinical Centre of Vojvodina, 110 subjects were included in our study and agreed to a one-year follow-up. At first check-up, 15% had low risk according to Framingham Weibull and 78% according to PROCAM, intermediate 12% according to PROCAM NS up to 45% according to Framingham Weibull, and high 8% according to PROCAM up to 40% according to Framingham Weibull. After a one-year treatment 30% were in the low risk category according to Framingham Weibull and 88% according to PROCAM. Intermediate from 10% according to PROCAM to 36% according to Framingham Weibull, and high from 2% according to PROCAM to 25% according to Framingham Weibull. There is a significantly lower percentage of high risk individuals and a higher percentage of low risk individuals after one year of lipid disorder treatment.

Open access

Snežana Jovičić, Svetlana Ignjatović and Nada Majkić-Singh

Comparison of Two Different Methods for Cardiovascular Risk Assessment: Framingham Risk Score and Score System

Numerous studies have shown that the major risk factors for coronary heart disease (cigarette smoking, hypertension, elevated serum total cholesterol and low-density lipoprotein cholesterol - LDL, low serum high-density lipoprotein cholesterol - HDL, diabetes mellitus and advancing age), are additive in predictive power. Accordingly, the total risk of a person can be estimated by summing up the risk imparted by each of the major risk factors. Using data obtained from population studies, various risk assessment algorithms have been developed. The aim of this study was to compare the two most common risk scores. Risk assessment for determining 10-year risk in 185 healthy, asymptomatic individuals of both sexes, 30-85 years old, was carried out according to both Framingham (FRS) and SCORE risk scoring. The risk factors included in the calculation of 10-year risk are gender, age, total cholesterol, HDL-cholesterol, systolic blood pressure, treatment for hypertension and cigarette smoking. The determinations of total cholesterol and HDL-cholesterol were made in sera collected after a 12h fasting period using an Olympus AU2700 automated analyzer. The Framingham risk score was determined using an electronic calculator - ATP III Risk Estimator, and the risk status according to SCORE was obtained using charts for the 10-year risk in populations at high risk. Among 185 participants, in 152 (82%) 10-year risk for Coronary Heart Disease (CHD) death was <10%, 24 (13%) had intermediate and 9 (5%) had high risk (⩾20%) according to FRS. According to SCORE, 110 (60%) participants had <1%, 56 (30%) had 1-5% and 19 (10%) had ⩾5% of 10-year risk for cardiovascular death. Different categories of risk were assigned to ~30% of individuals according to different risk assessment models. Differences in risk classification when using two different risk assessment algorithms can be explained with several important issues, including different endpoints, consideration of interactions and incorporation of antihypertensive use. It is important to note that neither FRS nor SCORE have been appropriately adjusted for our population, according to the national cardiovascular mortality rate.

Open access

Veroslava Stanković, Svetlana Stojanović and Nađa Vasiljević

Summary

People with metabolic syndrome (MetSy) are about twice as likely to develop cardiovascular disease and over four times as likely to develop type 2 diabetes compared to subjects without metabolic syndrome. Waist circumferences (WC) and body mass index (BMI) are useful screening tools for making the diagnosis. MetSy has increased the health risk in primary care. The aim of the study was to evaluate the anthropometric indices for MetSy and determine which of simple anthropometric measurements is most closely associated with metabolic risk factors.

The research included 264 individuals, of which 132 men with mean age (±SD) of 44.73 ±9.37 years and 132 women with mean age (±SD) of 46.67±8.44 years. Antropometric indicators were measured using standard protocols, without shoes and outerwear. BMI was calculated as weight/height2(kg/m2) ratio, as recommended by the World Health Organization (WHO). Blood pressure measurements were obtained with the subject in a seated position by using a standard mercury sphygmomanometer. Blood samples were obtained after a minimum of 12-h fast; the metabolic parameters (high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, triglycerides, blood glucose) were analyzed by standard procedures. Analysis of the examinees’ medical records was also performed. Metabolic syndrome was diagnosed using the International Diabetes Federation (IDF) criteria. The analysis of the research results were performed using the Statistical Package for Social Science version 10.0 (SPSS 10.0 for Windows).

The prevalence of the metabolic syndrome was 44.7% in men and 43.2% in women. Normal-weight subjects of both sexes were significantly younger and had significantly lower blood glucose, total cholesterol, LDL and triglycerides than overweight and obese subjects. Systolic and diastolic blood pressure values were significantly increased in parallel with increasing of BMI. For the whole sample, both anthropometric indices had significant associations with the other five components of MetSy.

Waist circumference is a simple measure of adiposity most strongly associated with metabolic abnormalities. The results obtained in this study indicate that WC is a good indicator of health risk in women but not in men. Measurement of WC by BMI categories may indicate a person with an increased risk of development of chronic diseases.

Open access

Milena Milićević and Srećko Potić

SUMMARY

For more than three decades, assisted reproductive techniques (ART) have been used as effective treatments to overcome infertility. Since then, numerous studies have been focused on different aspects of long-term health and development of children born after assisted conception. The aim of this paper is to summarize new data on multiple pregnancy and preterm delivery as one of the risk factors which might increase the risk of developing cerebral palsy (CP) in children born after assisted conception.

A comprehensive search of eight databases retrieved 108 papers, 10 of which met inclusion criteria and were relevant for this review.

Despite the dissimilarities in methodological and analytic approaches in the selected studies, in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are generally considered safe, still there is an ongoing discussion whether multiple pregnancy and preterm delivery increase or do not increase the risk of CP in children born after assisted conception.

All information about possible adverse maternal and/or infant outcomes should be made available to the couples seeking ART treatment

Open access

Amirhossein Sahebkar

Summary

Background: C-reactive protein (CRP) has been proposed as a risk marker and risk factor of cardiovascular disease. There have been a number of clinical reports suggesting that supplementation with L-carnitine can modulate systemic inflammation and lower circulating CRP concentrations, but the results have not been consistent.

Methods: A comprehensive literature search in Medline, Scopus and Cochrane Central Register of Controlled Trials was performed in December 2012 to identify clinical trials investigating the impact of oral L-carnitine supplementation on serum/plasma CRP concentration. A random effect method was used to calculate the combined effect size.

Results: Six studies comprising 541 cases and 546 controls met the inclusion criteria. Meta-analysis of included trials revealed a significant reduction of circulating CRP concentrations in subjects under L-carnitine intervention compared to the control treatment. The calculated combined weighted mean reduction in CRP concentrations was -0.39 mg/L [95% CI (-0.62 - -0.16)]. This effect size estimate was found to be robust and remained unaffected by the removal of each single study.

Conclusions: The overall findings of the present metaanalysis support the clinically relevant benefit of L-carnitine supplementation in lowering the circulating levels of CRP.

Open access

Eva Mračková, Verica Milanko, Dušan Gavanski and Borislav Simendić

radova; Savetovanje Procena rizika, Kopaonik, 2010, s. 447-455, ISBN 978-86-84853-66-2. (in Croatian). MRAČKOVÁ, Eva (2006). Confronting the explosion protection problem. In: Ekonomski aspekti zastite radne i zivotne sredine: zbornik radova/XIV Naucni skup"Covek i radna sredina", Nis 2006, p. 125-133, ISBN 86-80261-69-6. N01-ES-85421 (2000). Wood Dust, RoC Background Document for Wood Dust, 2000, Public Health Service National Toxicology Program U.S., Contract Number N01-ES-85421, p. 9-22. OČKAJOVÁ, Alena, BELJO, Lučić

Open access

Ana Mrkaić, Suzana Branković, Pavle Randjelović, Milica Veljković, Ivan Pavlović and Mirjana Radenković

Summary

Smoking has many harmful effects on human body. It is well known that smoking is one of the most important risk factors for cardiovascular diseases. Though the ingredients from cigarette smoke stimulate the release of vasoconstrictor and reduce the release of vasodilator substances, the goal of this study was to investigate the acute effects of smoking on arterial blood pressure, heart rate and blood vessel flow.

The investigation was conducted on forty healthy volunteers divided into two groups of twenty non-smokers (control group), and twenty smokers (experimental group). The group of smokers was examined before and after smoking four cigarettes during one hour. Blood pressure and electrocardiograph (ECG) were measured by common methods. Brecht’s and Boucke’s methods of plethysmography were used to evaluate the peripheral circulation.

There were no differences in measured systolic and diastolic blood pressure and recorded ECG between non-smokers and smokers, neither between smokers before and after smoking. However, heart rate was increased by 29.57% after smoking in comparison to the value before smoking.

Evaluation of plethysmographic parameters showed that amplitude was significantly decreased. Parameters of peripheral resistance were very increased: ductility was decreased by over 20%.

It can be concluded that acute smoking does not significantly affect the level of blood pressure, although it increases heart rate. The shape of plethysmograms showed decreased systolic filling and decreased diameters of blood vessels.

Open access

Nedim Hamzagic, Marija Andjelkovic, Marijana Stanojevic Pirkovic, Petar Canovic, Milan Zaric and Dejan Petrovic

. Petrović D, Trbojević-Stanković J, Stojanović- Marjanović V, Nikolić A, Miloradović V. Iznenadna srčana smrt bolesnika na hemodijalizi: procena rizika i prevencija. Ser J Exp Clin Res 2013; 14(1): 29-32. 8. Murray AM, Knopman DS, Tupper DE, Kane R. Cognitive impairment in hemodialysis patient is common. Nephrology 2006; 67(2): 216-23. 9. Murray AM, Pederson SL, Tupper DE, Hochhalter AK, Miller WA, Li Q, et al. Acute variation in cognitive function in hemodialysis patients: a cohort study with repeated measures. Am J Kidney Dis 2007; 50

Open access

Snezana Radovanovic, Dragan Vasiljevic, Sanja Kocic, Svetlana Radevic, Mirjana Milosavljević and Nataša Mihailovic

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