[Pleiotropic Effects of Statins - What Is Their Clinical Significance?].

Pleiotropic Effects of Statins - What Is Their Clinical Significance? Pleiotropic Effects of Statins - What Is Their Clinical Significance? Statins have several pleiotropic effects, such as anti-inflammation, anti-thrombotic effects, inhibition of smooth muscle cell proliferation and apoptosis, inhibition of migration and activation of macrophages. They increase blood glucose with the exception of pitavastatin. The clnical importance of the pleiotropic effects of statins however remains unclear.

Vitamin D levels in Swiss breast cancer survivors.

Background: Cholecalciferol (vitamin D3) is widely supplemented in breast cancer survivors because of the role of vitamin D in multiple health outcomes.

Methods: We conducted an observational study in 332 women in Eastern Switzerland with early, i.e.

[Inhibitors of PCSK9].

Observational data show a consistent association between elevated low density lipoproteins (LDL-C) and cardiovascular disease (CVD). Reduction of LDL-C reduces the risk of CVD as has been shown by many trials. Statins are currently the most effective drugs for lowering LDL-C, but can present side effects which might limit the prescribed dosage and prevent patients from reaching the recommended LDL levels.

Toward a more professional and practical medical education: a novel Central European approach.

We here present an innovative curriculum for a complete medical education that conforms to the current European Bologna system of academic training. The curriculum aims at raising doctors who are excellently prepared for clinical work over as short a time as 5 years; it provides a comprehensive, yet shorter than usual, education that strongly pronounces the importance of increasing the students' practical clinical competences and rigorously excludes superfluous contents. The curriculum encompasses 52 modules, 32 at the bachelor's and 20 at the master's level.

[Statin treatment in primary and secondary prevention--a statement].

Although lipid-lowering therapy in patients with established coronary heart disease (secondary prevention) is generally accepted, its benefit is often questioned in asympto- matic patients. The ongoing debate about the usefulness of statin therapy has disturbed many patients, especially in the French- and Italian-speaking parts of Switzerland, which lead too often to treatment discontinuation, even in patients who would benefit the most from it. In the primary prevention, the reduction in LDL cholesterol levels with statins decreases the risk for cardiovascular events.

Treat-to-target versus dose-adapted statin treatment of cholesterol to reduce cardiovascular risk.

Clinical guidelines should be based on the best available evidence and are of great importance for patient care and disease prevention. In this respect, the 2013 American College of Cardiology/American Heart Association report is highly appreciated and well-recognized. The report included critical questions concerning hypercholesterolaemia, but its translation into a clinical guideline initiated intense debate worldwide because of the recommendation to switch from a treat-to-target approach for low-density-lipoprotein-cholesterol to a statin dose-based strategy.

New AHA and ACC guidelines on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk.

After the publication of the new guidelines of the European Society of Cardiology and the European Atherosclerosis Society for the prevention and treatment of dyslipidemias (Eur Heart J 32:1769-1818, 2011; Eur Heart J 33:1635-1701, 2012), a group of authors has recently published on behalf of the American Heart Association and the American College of Cardiology guidelines on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk (Circulation 2013). These new guidelines are supposed to replace the until now widely accepted, at least in the USA, recommendations of the National Cholesterol Education Program Adult Treatment Panel III from the years 2002 (Circulation 106:3143-3421, 2002) and 2004 (Circulation 110:227-39, 2004). Furthermore, they claim to be based mainly on hard evidence derived from the interpretation of results of prospective randomized controlled trials.

Performance evaluation of the Access FT3 and FT4 assays, comparison with Immulite and AxSym, and the relationship to TSH values.

Background: Different FT3 and FT4 assays report significantly different results. We compared the distribution of FT3 and FT4 in a cohort of Swiss patients measured with DxI 800, AxSYM, and Immulite 2000.

Methods: TSH, FT3, and FT4 values were measured in 1,938 serum samples.

[New european guidelines for dyslipidemia].

Lifestyle changes should be considered before anything else in patients with dyslipidemia according to the new guidelines on dyslipidemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). The guidelines recommend the SCORE system (Systematic Coronary Risk Estimation) to classify cardiovascular risk into four categories (very high, high, medium or low risk) as the basis for treatment decisions. HDL cholesterol, which is inversely proportional to cardiovascular risk, is included to the total risk estimation.

Diagnostic accuracy of point-of-care testing for acute coronary syndromes, heart failure and thromboembolic events in primary care: a cluster-randomised controlled trial.

Background: Evidence of the clinical benefit of 3-in-1 point-of-care testing (POCT) for cardiac troponin T (cTnT), N-terminal pro-brain natriuretic peptide (NT-proBNP) and D-dimer in cardiovascular risk stratification at primary care level for diagnosing acute coronary syndromes (ACS), heart failure (HF) and thromboembolic events (TE) is very limited. The aim of this study is to analyse the diagnostic accuracy of POCT in primary care.

Methods: Prospective multicentre controlled trial cluster-randomised to POCT-assisted diagnosis and conventional diagnosis (controls).

Impact of enhanced compliance initiatives on the efficacy of rosuvastatin in reducing low density lipoprotein cholesterol levels in patients with primary hypercholesterolaemia.

Background: The effectiveness of lipid-lowering medication critically depends on the patients' compliance and the efficacy of the prescribed drug.

Objectives: The primary objective of this multicentre study was to compare the efficacy of rosuvastatin with or without access to compliance initiatives, in bringing patients to the Joint European Task Force's (1998) recommended low-density lipoprotein cholesterol (LDL-C) level goal (LDL-C, <3.0 mmol/L) at week 24.

[What are the biomarkers of atherosclerosis and cardiovascular risk?].

A large number of novel biomarkers of cardiovascular risk have recently been identified. To be implemented in clinical practice these biomarkers should fulfill certain requirements, such as independance of other risk factors, improvement of the prediction by global risk assessment, and a therapeutic implication (modifiable risk). Some of these new risk markers have shown a clinical importance under certain circumstances (hsCRP, Lp(a), markers of renal insufficiency, or fibrinogen).

Prevalence of microalbuminuria in the general population of Seychelles and strong association with diabetes and hypertension independent of renal markers.

Objective: Few studies have examined microalbuminuria (MAU) in non-western populations. We assessed the prevalence of MAU in the general population of a middle-income country in the African region and relationships between MAU and selected cardiovascular risk factors.

Methods: An examination survey was conducted in a sample representative of the entire population aged 25-64 years in the Seychelles.

Heparinized blood provides equivalent results to EDTA in the CEDIA and FPIA cyclosporine immunoassays, thus facilitating routine cyclosporine determination.

Background: CsA measurements are routinely used to allow adequate CsA dosage adjustments. CsA assays routinely require EDTA anticoagulated whole blood; EDTA has been preferred due to differences seen when using heparinized blood in the past. We hypothesized that with new, robust assays, heparinized blood might be appropriate for measuring CsA levels.

Microalbuminuria, but not cystatin C, is associated with carotid atherosclerosis in middle-aged adults.

Background: Cystatin C, a marker of renal function, has been shown to be an independent predictor of cardiovascular disease (CVD) in older adults, but few data are available in middle-aged adults. Moreover, no study has compared cystatin C and microalbuminuria as risk factors for CVD outcomes in middle-aged adults, and it is not known whether cystatin C is related to an early stage of atherosclerosis.

Methods: We evaluated the relationships between serum creatinine, estimated glomerular filtration rate (GFR), serum cystatin C (all divided into tertiles), microalbuminuria and carotid atherosclerosis in a population-based random sample of 523 adults aged 35-64 years from the Seychelles (Indian Ocean).

Economic impact of hyperhomocysteinemia in Switzerland.

Since more than 20 years elevated homocysteine plasma levels have been associated with an elevated cardiovascular risk. It can be assumed that approx. 5-7% of the Swiss population suffers from hyperhomocysteinemia.

Statin-induced immunomodulatory effects on human T cells in vivo.

Statins are widely used for treatment of hypercholesterolemia. Recent experimental studies revealed that these drugs also exert anti-inflammatory effects. The aim of this study was to assess immunomodulatory effects of statins in humans in vivo.

Lipid-lowering therapy: strategies for improving compliance.

Lowering cholesterol levels is a primary approach for reducing the risk of coronary heart disease (CHD), yet patients rarely achieve the lipid targets recommended by international guidelines. Although high rates of compliance and achievement of lipid targets have been reported in clinical trials, this situation is infrequently reproduced in regular practice. This sub-optimal lipid management has clinical consequences as patients will not gain the full benefit of treatment.