TABLE OF CONTENTS . Rezidualni rizik — danas, sutra Residual risk — today, tomorrow p. 294 . SrËane bolesti u djeluAmatusa Lusitanusa Cardiac diseases in the writtings ofAmatus Lusitanus p. 299 . Zapisnik sa sjednice UO HKD 12. listopada 2010. Minutes of the Meeting of the CCS MB on 12 Oct 2010 p. 302 . Zapisnik s Izborne skupptineHKD 23. listopada 2010. Minutes of the Elective Assembly of the CCS 23 Oct 2010 p. 305 . “Radim za srce”: “I Work with Heart”: Zagreb SplitOsijekKorËula p. 309 p. 311p. 312 p. 313 . Novosti s 21. internacionalnogkongresa o trombozi Novelties from the 21st International Congress on Thrombosis p. 314 . Radionica “UltrazvuËna dijagnostika u prevenciji irehabilitaciji KVB Workshop “UltrasoundDiagnostict in Prevention and Rehabilitation of CVD p. 316 . 5 god. invazivne kardiologijeu KBC Osijek Five-Year of Invasive Cardiology in Osijek p. 318 . Iz povijesti kardiologije u ZagrebuFrom the history of Cardiology in Zagreb p. 320 . ©to jop moæemo uËiniti ulijeËenju pacijenata s hiperlipidemijom? What more can we do when treating patients with hyperlipidemia? p. 321 2010;5(12):294. StruËni rad Professional article 2010;5(12):294. StruËni rad Professional article Rezidualni rizik — danas, sutra ...; jop jedan pogled na rezultate ACCORD studije i podstudija Residual risk — today, tomorrow ...; Another look at the results of the ACCORD study and sub-studies Goran KrstaËiÊ* Poliklinika za prevenciju kardiovaskularnih bolesti i rehabilitaciju, Zagreb, Hrvatska Institute for Cardiovascular Diseases Prevention and Rehabilitation, Zagreb, Croatia SAÆETAK: Postoje nedvojbeni dokazi da unatoË uËinkovitom sniæenju LDL, arterijskog tlaka (AT) i glukoze u krvi (GUK), uËinci sniæenja vaskularnog rizika nisu dostatni, poglavito zbog aterogene dislipidemije u bolesnika s dijabetesom i metaboliËkim sindromom. ACCORD (Action to Control Cardiovasular Risk in Diabetes) predstavlja globalnu kliniËku studiju koja je imala za cilj utvrditi moguÊnost smanjenja kardiovaskularnih doga.aja i mikrovaskularnih komplikacija intenzivnom regulacijom GUK (HbA1c <6.0% naspram 7.0-7.9%), dislipidemije (simvastatin i fenofibrat naspram simvastatina) i povipenog AT (vrijednosti sistoliËkog AT <120 naspram <140 mmHg). Prva studija “intezivne glukoregulacije” prekinuta je nakon 3,5 godine praÊenja (18 mjeseci prije planiranog kraja), poradi 54 smrtna ishoda vipe u grupi intenzivno lijeËenih ispitanika sa zakljuËkom da inzistiranje na normalizaciji glikemije i HbA1c <6% moæe biti kontraproduktivno te treba zauzeti individualan pristup lijeËenja kod dijabetiËara. Rezultati druge studije nakon pet godina pokazali su da “intenzivna regulacija” AT nije smanjila primarne ishode (nefatalni infarkt miokarda, ukupnu smrtnost ili smrt od kardiovaskularnog uzroka). TreÊa studija “intenzivnog lijeËenja” dislipidemije pokazala je da primjena kombinacije fenofibrata i simvastatina ne smanjuje pojavnost smrtonosnog kardiovaskularnog doga.aja, ne-smrtonosnog infarkta miokarda ili ne-smrtonosnog moædanog udara u usporedbi s monoterapijom simvastatinom. Poslije zavrpetka ACCORD studije razvidno je da u osoba s dijabetesom tipa 2 i povipenim kardiovaskularnim rizikom treba prilagoditi terapijske ciljeve uz obveznu individualizaciju pristupa bolesniku. KLJU»NE RIJE»I: dijabetes tipa 2, arterijski tlak, intenzivne ciljne vrijednosti, kardiovaskularni rizik. I I nicijativa za smanjenje ostatnog rizika (R3i) je akademska, multidisciplinarna, neprofitna edukacijska fundacija posveÊena nastojanjima da se smanji znaËajan preostali rizik u razvitku makrovaskularnih doga.aja i mikrovaskularnih komplikacija koje perzistiraju u veÊine bolesnika unatoË optimalnoj standardnoj terapiji i postizanjuciljnih vrijednosti sukladno smjernicama. UnatoË dokazanoj djelotvornosti postojeÊe standardne terapije, bolesnici, a navlastito dijabetiËari i dalje su izloæeni znakovitom ostatnom riziku koji vodi u razvitak makrovaskularnih doga. aja (infarkta miokarda i cerebrovaskularnog inzulta), odnosno mikrovaskularnih komplikacija (retinopatije, nefropatije i neuropatije)1. ZnaËenje rezidualnog ili ostatnog krvoæilnog rizika nedvojbeno je, barem dijelom, vezano uzpostojanje aterogene dislipidemije (poveÊani trigliceridi i/ili preniski HDL), kod koje terapija statinima ne postiæe SUMMARY: There is undoubted evidence that despite a strong reduction of LDL, blood pressure (BP) and blood glucose, the effects of reducing the vascular risk are not sufficient, especially due to aterogenous dyslipidemia in patients with diabetes and metabolic syndrome. ACCORD (Action to Control Cardiovasular Risk in Diabetes) represents a global clinical study that was aimed at determination of a possibility of reducing cardiovascular events and microvascular complications by intensive regulation of glucose (HbA1c <6.0% vs. 7.0-7.9%), dyslipidemia (simvastatin and fenofibrate vs. simvastatin) and higher BP (the values of systolic BP <120 vs. <140 mmHg). The first study of “intensive glucoregulation” was interrupted after 3.5 years of follow- up (18 months prior to the forecasted end), as a result of 54 fatal outcomes more in the group of intensively treated patients thereby reaching a conclusion that insisting on normalization of glycemia and HbA1c <6% may be counterproductive and an individual approach to treatment in case of diabetics should be taken. The results of the other study after five years showed that “intensive regulation” of BP resulted in no reduction of primary outcomes (non-fatal myocardial infarction, total mortality or death from cardiovascular cause). The third study of “intensive treatment” of dyslipidemia showed that the combination of fenofibirate and simvastatin does not reduce the occurrence of fatal cardiovascular event, non-fatal myocardial infarction or non-fatal stroke compared with monotherapy by using simvastatin. After the end of the ACCORD study, it is obvious that the therapy targets should be adapted to the persons having diabetes type 2 and higher cardiovascular risk thereby taking an individual approach to a patient. KEYWORDS: diabetes type 2, blood pressure, intensive target values, cardiovascular risk. CITATION: Kardio list. 2010;5(12):294-298. T T he initiative for reduction of residual risk (R3i) is the academic, multidisciplinary, non-profit educational foundation committed to endeavors to reduce a significant residual risk in development of macrovascular events and microvascular complications that persist in the most of the patients despite the optimum standard therapy and accomplishment of target values according to the guidelines. Besides the proven efficiency of the existing standard therapy, the patients, especially the diabetics are still exposed to significant residual risk that leads to the development of macrovascular events (myocardial infarction and stroke), that is, microvascular complications (retinopathy, nephropathy and neuropathy)1. The meaning of the residual cardiovascular risk is undoubtedly at least partly linked to the existence of aterogenous dyslipidemia (increased triglycerides and/or decreased HDL), in case of therapy with statins, no significant results are achieved. For example, 2010;5(12):295. znaËajnije rezultate. Primjerice, dok je u proteklih tridesetak godina u SAD prevalencija povipenih vrijednosti LDL-a sniæena za 7,2%, prevalencija kombinacije povipenih triglicerida i niskog HDL-a je udvostruËena, a prevalencijasamo povipenih triglicerida je Ëak upeterostruËena!2 To jepoglavito u svezi uz sve veÊi broj pretilih osoba s metaboliËkim sindromom i sve veÊu uËestalost dijabetesa tipa 2. Stoga je potrebito razviti novu strategiju koja bi mogla bolje djelovati na riziËne Ëimbenike, poglavito aterogenu dislipidemiju navlastito u cilju sniæavanja ostatnog rizika u bolesnika s dijabetesom i krvoæilnim bolestima.3 ACCORD (Action to Control Cardiovasular Risk in Diabetes) je velika i vaæna globalna kliniËka studija koju je financirao National Institute of Health iz SAD. Ona je obuhvatila tri studije u jednom programu istraæivanja i imala jeza cilj utvrditi moguÊnost smanjenja kardiovaskularnih doga .aja i mikrovaskularnih komplikacija kod bolesnika s dijabetesom tipa 2 postizanjem intenzivnih ciljnih vrijednosti tri znaËajna Ëimbenika rizika u usporedbi sa standardnim pristupom u uËinkovitoj prevenciji kardiovaskularnih bolesti: • intenzivna glukoregulacija (vrijednost HbA1c <6,0% naspram vrijednosti 7-7,9%); • intenzivno lijeËenje dislipidemije (simvastatin + fenofibrat naspram simvastatin); • intezivno lijeËenje povipenog arterijskog tlaka (AT) (vrijednosti sistoliËkog AT <120 mmHg naspram <140 mmHg). Studija je zapoËela 2001. god. s ukljuËenih 10.251 ispitanika u 73 centra u SAD i Kanadi. Ispitanici su bili dijabetiËari tipa 2, prosjeËne dobi od 62,2 god. U vrijeme ukljuËenja u studiju ispitanici su veÊ lijeËili dijabetes prosjeËno deset godina i imali prosjeËnu vrijednost HbA1c od8,1% te su imali krvoæilnu bolest ili najmanje 2 Ëimbenika rizika za kardiovaskularni pobol (arterijska hipertenzija, hiperkolesterolemija, pretilost ili pupenje). U ovoj skupinibolesnika stopa smrtnosti inaËe iznosi 50/1.000 osoba (5% godipnje)4. U prvoj studiji, studiji “intenzivne glukoregulacije”, ispitanici su podijeljeni u skupinu intenzivnog pristupa uuËinkovitoj prevenciji kardiovaskularnih bolesti (HbA1c <6%) koja je analizirana u odnosu na standardni pristup (HbA1c 7-7,9%). Za postizanje terapijskih ciljeva koripteni su metformin, preparati sulfonilureje, tijazolidindioni, inzulin i akarboza. ProsjeËno je oko 9 mjeseci bilo potrebno da se dostigne terapijski cilj. Ispitanici skupine intenzivnoglijeËenja kontrolirani su svakih 2 mjeseca, a oni standard- no lijeËeni svaka 4 mjeseca. Primarni cilj je bila pojava prvog ne-fatalnog infarkta miokarda ili ne-fatalnog moædanog udara ili smrti kardiovaskularnog uzroka. U trenutkuprekidanja studije nakon 3,5 godine praÊenja, 18 mjeseciprije planiranog kraja, u skupini intenzivno lijeËenih ispitanika prosjeËni HbA1c iznosio je 6,4%, a u grupi standardno lijeËenih 7,5%. U standardno lijeËenoj skupini ispitanika zabiljeæeno je 11 smrtnih ishoda na 1.000 ispitanika tijekom 4 godine praÊenja, a u skupini intenzivno lijeËenih ispitanika 14. U obje skupine ovaj neæeljeni ishodbio je znakovito niæi od oËekivanog, no razlika od 54 smrtna ishoda vipe u skupini intenzivno lijeËenih ispitanika(257 prema 203) znaËio je razliku od 3 osobe na 1.000 osoba u prosjeku tijekom Ëetverogodipnjeg razdoblja praÊenja i desetoËlani Odbor za praÊenje The National Heart, while during the last thirty years, the prevalence of increased values of LDL has been reduced by 7.2% in the USA, the prevalence of the combination of increased triglycerides and low HDL has been doubled, while the prevalence of only increased triglycerides has been increased even five times!2 This is especially connected with ever greater number of obese persons with metabolic syndrome and more frequent diabetes type 2. Therefore, it is necessary to develop a new strategy that may better impact the risk factors, especially aterogenous dyslipidemia mainly for the purpose of lowering the residual risk in patients with diabetes and cardiovascular diseases3. ACCORD (Action to Control Cardiovasular Risk in Diabetes) is a large and important global clinical study financed by the National Institute of Health, USA. It included the three studies in one research program with an aim to determine the possibility of reducing the cardiovascular events and microvascular complications in patients with diabetes type 2 by achieving intensive target values of three risk factors in comparison with standard approach in efficient prevention of cardiovascular disease: • Intensive glucoregulation (value HbA1c <6.0% vs. the value 7-7.9%); • Intensive treatment of dyslipidemia (simvastatin + fenobrate vs. simvastatin); • Intensive treatment of higher blood pressure (BP) (value of systolic BP <120 mmHg vs. <140 mmHg). The study started in 2001 which included 10.251 patients in 73 centers in the USA and Canada. The patients were the diabetics type 2 with average age of 62.2. At the time of involvement in the study, the patients had already been treated from diabetes for ten years on average and had an average value of HbA1c of 8,1% and had a cardiovascular disease or at least 2 risk factors for cardiovascular disease (hypertension, hypercholesterolemia, obesity or smoking). In this group of patients, the mortality rate is generally 50/1000 persons (5% per annum)4. In the first study, the study of “intensive glucoregulation”, the patients were divided in the group of intensive approach in efficient prevention of cardiovascular diseases (HbA1c <6%) that was analyzed compared to the standard approach (HbA1c 7-7.9%). Metformin, the sulphonilurea, thiazolidinedione drugs, insulin and acarbose were used for the achievement of therapeutic targets. On average, it takes some 9 months to achieve a therapeutic target. The patients included in the group for intensive treatment were controlled every two months, while those who underwent standard treatment were controlled every four months. The primary goal was the occurrence of non-fatal myocardial infarction or non-fatal stroke or death of cardiovascular cause. At the time of interruption of the study, after 3.5 years of follow-up, 18 months prior to the forecasted end, the average HbA1c was 6.4% in the group of intensively treated patients, while there were 7.5% of them in the group undergoing standard treatment. The group of patients undergoing standard treatment recorded 11 fatal outcomes per 1000 during 4 years of follow-up, while the group of patients undergoing intensive treatment recorded 14 fatal outcomes. In the both groups, this adverse outcome was much lower than the expected one, but the difference of 54 fatal outcomes more in the group of patients undergoing intensive treatment (257 vs. 203) meant a difference of 3 persons per 1000 patients on average during the four-year period of follow-up and ten-member follow- up Board The National Heart, Lung, and Blood Institute suggested the interruption of this branch of the study. The patients continued the treatment till the forecasted end of the study by using the standard therapy. The researchers 2010;5(12):296. 2010;5(12):296. Lung, and Blood Institute predloæio je prekid ove granestudije. Ispitanici su nastavili lijeËenje do planiranog krajastudije standardnom terapijom. IstraæivaËi su potom analizirali dostupne podatke, ali nisu mogli izdvojiti uzrok veÊesmrtnosti u intenzivno lijeËenoj skupini. Razvidno je da hipoglikemija niti neki lijek (ukljuËujuÊi i rosiglitazon koji jezbog upozorenja poËetkom 2007. godine posebito analiziran kod ispitanika koji su ga koristili) nije bio uzrok registriranoj razlici u preæivljavanju. Nije zanemariva niti Ëinjenica da su primarni ishodi, biljeæeni zbrojem infarkta miokarda (IM), cerebrovaskularnog inzulta (CVI) i kardiovaskularnih smrtnih ishoda, bili 10% niæi u intenzivno lijeËenih ispitanika5. ZakljuËeno je da u dijabetiËara tipa 2 s posebno visokim rizikom za kardiovaskularni pobol inzistiranje na normalizaciji glikemije i HbA1c niæem od 6% moæe biti kontraproduktivno i da stoga ne bi trebalo zauzeti isti pristup lijeËenja kod svih dijabetiËara. Ovo je u skladu sa preporukama American Diabetes Association koja preporuËa glukoregulaciju po kojoj HbA1c treba biti niæi od 7% ali uz individualnu prilagodbu terapijskih ciljeva. Kod osoba koje su sklone tepkim i Ëestim hipoglikemijamaili osoba s ograniËenim oËekivanim preæivljavanjem trebaimati manje ambiciozne ciljeve glukoregulacije. IstraæivaËi su tako.er pokazali da intenzivna glikemijska terapija nijeimala znaËajan uËinak na razvijenim mikrovaskularnim komplikacijama na kraju studije nakon 5 godina, ali su registrirali usporenje progresije mikrovaskularnih komplikacija. Zabiljeæeno je smanjenje albuminurije s primjenom intenzivne glikemijske kontrole (1,44 mmol/L naspram 1,63 mmol/L u standardnoj skupini), jednako kao i usporenje progresije retinopatije i neuropatije usporedivo sa standardnim lijeËenjem. Ova korist se treba usporediti s potencijalnim negativnim posljedicama povezanim s intenzivnom glikemijskom terapijom o kojoj je ranije ACCORDizvijestio, ukljuËujuÊi tu veÊu ukupnu smrtnost i smrtnostuslijed kardiovaskularnih posljedica, poveÊanje tjelesne teæine, kao i tepke hipoglikemije u bolesnika s visokim rizikom od kardiovaskularnih bolesti5. Kontrola glukoze jevjerojatno uËinkovitija u prevenciji nego kada veÊ postoje komplikacije dijabetesa. Rezultati ACCORD studije ne mogu se primijeniti na bolesnike s tipom 1 dijabetesa. U drugoj studiji, studiji “intenzivnog lijeËenja arterijskog tlaka” 4.733 ispitanika s dijabetesom tip 2 je bilo randomizirano na skupinu intenzivnog lijeËenja s ciljem sniæenja vrijednosti AT <120 mmHg, dok je u drugoj skupinilijeËenja ciljna vrijednost sistoliËkog AT bila <140 mmHg. ProsjeËno praÊenje iznosilo je 4,7 god., a primarni cilj je bio isti kao i u ostale dvije grane ACCORD studija. Rezultati su pokazali da intenzivna regulacija AT nije smanjila primarne ishode (nefatalni IM, ukupnu smrtnost ili smrt odkardiovaskularnog uzroka). Ozbiljni neæeljeni uËinci (hipotenzija, sinkopa, bradikardija ili aritmije, hiperkalijemija, zatajenje bubrega, smanjenje glomerularne filtracije <30 mL/min/1,73m2) zabiljeæeni su u skupini intenzivnoglijeËenja kod 3,3%, za razliku od standardnog lijeËenja 1,3% ispitanika. Vrijedi napomenuti da je intenzivno lijeËenje AT ipak dovelo i do nekih pozitivnih rezultata ptose oËitovalo kroz smanjenje sekundarnih ciljeva, tj. ukupno smanjenje CVI i nefatalnog CVI 6. TreÊa studija, studija intenzivnog lijeËenja dislipidemije (ACCORD Lipid Trial) trebala je dati odgovor da li bikombinirano lijeËenje statinom (simvastatin 20 ili 40 mg) i fenofibratom u dozi 160 mg u odnosu na monoterapiju sta analyzed the accessible data afterwards, but they could not determine the cause of increased mortality in the group of patients undergoing intensive treatment. It is obvious that hypoglycemia is not some medicine (including rosiglitazone that was at the beginning of 2007 because of this warning specifically analyzed in examinees that used it) and it was not some cause of registered difference in survival. We should not ignore the fact that the primary outcomes, followed by the sum of myocardial infarction (MI), stroke and cardiovascular fatal outcomes were lower by 10% in intensely treated patients5. It was concluded that in diabetics type 2 with especially high risk for cardiovascular disease, insisting on normalization of glycemia and HbA1c lower than 6% may be counter-productive and therefore we should not take the same approach to all diabetics. This is in compliance with the recommendations of American Diabetes Association that recommends the glucoregulation according to which HbA1c should be lower than 7%, but with individual adaptation of therapeutic targets. In patients who tend to suffer from serious and frequent hypoglycemia or persons with limited expected survival, we should have less ambitious glucoregulation targets. The researchers also showed that intensive glycemic therapy did not have a significant effect on developed microvascular complications at the end of the study after five years, recording a slowdown in progression of microvascular complications. The reduction of albuminuria was recorded thereby applying the intensive glycemic control (1.44 mmol/L vs 1.63 mmol/L in the group undergoing standard treatment), and the slowdown of progression of retinopathy and neuropathy applying standard treatment was recorded. This benefit should be compared to potential negative consequences linked to the intensive glycemic therapy as previously reported by ACCORD, including this larger total mortality and mortality as a consequence of cardiovascular diseases, increased body weight and serious hypoglycemia in patients with a high risk of cardiovascular disease5. The control of glucose is probably more efficient in prevention than when the diabetes complications already exist. The results of the ACCORD study may not be applied to patients with type 1 diabetes. In the second study, the study of “intensive treatment of BP” some 4,733 patients with type 2 was randomized to the group undergoing intensive treatment aimed at reducing the value of BP <120 mmHg, while in the second group of persons undergoing the treatment the target value of systolic BP was <140 mmHg. The average follow-up was 4.7 years, while the primary target was the same as in the remaining two branches of the ACCORD studies. The results showed that the intensive regulation of BP did not reduce the primary outcomes (non-fatal MI, total mortality or death from cardiovascular cause). The serious undesired effects (hypotension, syncope, bradycardia or arrhythmia, hypercaliemia, renal failure, reduction of glomerular filtration <30 mL/min/1,73m2) were recorded in the group of examinees undergoing intensive treatment in 3.3% of them, unlike the group undergoing standard treatment where they were recorded in 1.3% of examinees. It is worth mentioning that the intensive treatment of BP anyway caused some positive results reflected through the reduction of secondary targets, that is, total reduction of stroke and non-fatal stroke6. The third study, the study of intensive treatment of dyslipidemia (ACCORD LIPID Trial) should provide an answer whether the combined treatment by using statin (simvastatin 20 or 40 mg) and fenofibrate of 160 mg should re 2010;5(12):297. tinom smanjilo velike kardiovaskularne doga.aje. Cilj dodavanja fenofibrata je bio smanjenje razine triglicerida ipovipenje HDL kod bolesnika koji veÊ uzimaju statin glede sniæenja LDL. U studiji je sudjelovalo 5.518 bolesnika, aprosjeËno praÊenje iznosilo je 4,7 god. Rezultati su pokazali da kombinacija fenofibrata i simvastatina ne smanjuje pojavnost smrtonosnog KV doga.aja, ne-smrtonosnog IM ili ne-smrtonosnog CVI u usporedbi sa simvastatinom u monoterapiji. Ovi rezultati ne podræavaju rutinsku upotrebu kombinirane terapije u sniæavanju rizika kod veÊine bolesnika s dijabetesom tipa 2. No, u lipidnom kraku ACCORD studije bolesnici s dislipidemijom su imali za 70% veÊi relativni rizik za razvoj velikog KV doga.aja u usporedbi sa onima koji su imali trigliceride <2,3 mmol/L iHDL >0,88 mmol/L, unatoË postizanju ciljnih vrijednosti LDL od 2,0 mol/L. Dvadeset ovakvih bolesnika je potrebno lijeËiti kroz pet godina da bi se sprijeËio jedan KV doga .aj (NNT=20). Fibrati su pak, bili posebito uËinkoviti u smanjenju kardiovaskularnog relativnog rizika kod bolesnika na terapiji statinom s niskim HDL i povipenim trigliceridima, smanjujuÊi velike kardiovaskularne doga.aje za 31%. Kombinacija fenofibrata i statina je bila dobro podnopljiva i moæe se kazati da su rezultati lipidnog kraka ACCORD studije dodatno podræali aktualne smjernice lije- Ëenja dislipidemije koje podræavaju vaænost sveobuhvatnog pristupa lijeËenju lipidnih poremeÊaja7,8. Ranije studije su pokazale da dobra regulacija dijabetesa, dislipidemije i AT moæe biti vaæna u usporenju mikrovaskularnih komplikacija, poglavito progresije dijabetiËkeretinopatije. Recentno, ispitivaËi su objavili rezultate prespecificiranih podstudija uËinka terapije na progresiju retinopatije i druge mikrovaskularne komplikacije. IspitivaËi “ACCORD Eye Study” prikazali su rezultate prespecificirane podstudije praÊenja progresije retinopatije kod 2.856bolesnika dijabetiËara tip 29. Primarni cilj je bio zabiljeæba promjena na tzv. ljestvici retinopatije objektivizirano serijom fotografija retine koja ukupno sadræi 17 nivoa ili stupnjeva glede smanjenja najmanje tri nivoa (stupnja), ili pakpraÊenje razvoja retinopatije koja zahtijeva fotokoagulaciju ili vitrektomiju. Sekundarni cilj je bio praÊenjesmanjenja (gubitka) vida. »etverogodipnje praÊenje je pokazalo da u odnosu na standardnu terapiju: • intenzivna glikemijska terapija signifikantno sniæavauËestalost progresivne retinopatije (7,3% vs. 10,4%), ali ne i gubitak vida (16,3% vs. 16,7%); • intenzivno lijeËenje dislipidemije signifikantno smanjuje uËestalost progresivne retinopatije (6,5% vs. 10,2%), ali tako.er ne i gubitak vida (16,0% vs. 15,2%); • intenzivna antihipertenzivna terapija ne smanjujeprogresiju dijabetiËke retinopatije ili gubitak vida (10,4% vs. 8,8%; odnosno 19,4% vs. 15,8%). U ostalim podstudijama praÊenja drugih mikrovaskularnih komplikacija bolesnika koji su 3,5 godine bili na intezivnoj glukoregulaciji da bi potom 1,5 godinu bili nastandardnom lijeËenju u usporedbi s ispitanicima koji susvih pet godina bili na standardnom lijeËenju glukoregulacije zabiljeæeni su i drugi zanimljivi rezultati. Nakon petgodina zajedniËki primarni ishod (terminalna faza bubreæne insuficijencije, potreba za dijalizom ili transplantacijom bubrega, porast serumskog kreatinina >3,3mg/dL ili potreba za fotokoagulacijom retine ili vitrektomija) zabiljeæeno je kod 556 bolesnika u intezivnoj naspram 586 u standard duce large cardiovascular events compared to the mono- therapy with statin. The goal of adding fenofibrates was the reduction of the level of triglycerides and raising HDL in patients who already take statin for lowering LDL. Some 5,518 of patients participated in the study, and the average follow-up lasted for 4.7 years. The results showed that that the combination of fenofibrates and simvastatin do not reduce the occurrence of fatal cardiovascular event, non-fatal MI and non-fatal stroke in comparison to simvastatin monotherapy. These results do not support the routine use of combined therapy in lowering the risk in most of the patients with diabetes type 2. However, in the lipid branch of the ACCORD study, the patients with dyslipidemia had 70% larger relative risk for development of the large CV event compared to those that had triglycerides <2.3 mmol/L i HDL >0.88 mmol/L, despite the achievement of target values LDL of 2.0 mol/L. Twenty such patients need to be treated throughout a period of 5 years to prevent one CV event (NNT=20). Fibrates were especially efficient in lowering cardiovascular relative risk in patients on statin therapy with lower HDL and raised triglycerides, thereby reducing large cardiovascular events by 31%. The combination of fenofibrates and statin was well tolerable and we may say that the results of the lipid branch of the ACCORD study additionally supported the actual guidelines of treatment of dyslipidemia that support the importance of comprehensive approach to treatment of lipid disorders7,8. The previous studies showed that a good regulation of diabetes, dyslipidemia and BP may be important in slowing down microvascular complications, especially the progression of diabetic retinopathy. The investigators have recently published the results of prespecified sub-studies of effect of the therapy on the progression of retinopathy and other microvascular complications. The authors of “ACCORD Eye Study” showed the results of prespecified sub-study of monitoring the progression of retinopathy in 2,856 patients who have diabetes type 29. The primary goal was to record the changes to the so called scale of retinopathy objectivized by applying a series of photos of retina which totally contain 17 levels and degrees with regard to reduction of at least three levels (degrees), or monitoring the development of retinopathy that requires photocoagulation or vitrectomy. The secondary goal was monitoring of the reduction (loss) of eyesight. The four-year follow-up showed the below indicated compared to the standard therapy: • Intensive glycemic therapy significantly reduces the frequency of progressive retinopathy (7.3% vs. 10.4%), but not the loss of sight (16.3% vs. 16.7%); • The intensive treatment of dyslipidemia significantly reduces the frequency of progressive retinopathy (6.5% vs. 10.2%), but not the loss of sight (16.0% vs. 15.2%); • The intensive antihypertensive therapy does not reduce the progression of diabetic retinopathy or loss of eyesight (10.4% vs. 8.8%; that is, 19.4% vs. 15.8%). The other sub-studies of monitoring some other micro- vascular complications of patients undergoing intensive glucoregulation for 3.5 years, followed by undergoing standard treatment for 1.5 years compared to the examinees who underwent standard treatment of glucoregulation for all 5 years recorded some different and interesting results. After five years, the common primary outcome (terminal stage of renal insufficiency, the need for dialysis or 2010;5(12):298. 2010;5(12):298. noj skupini lijeËenja od ukupno 5.119 ispitanika10. Mikro-transplantation of kidneys, the rise in serum creatinine vaskularne bubreæne komplikacije temeljene na analizi urina ukazale su na signifikantno smanjenje mikroalbuminurije u skupini intezivnog lijeËenja glukoregulacije. Zabiljeæeno je smanjenje albuminurije od 21% u fazi tranzicije studije (nakon 3,5 godina praÊenja), dok je na kraju studije (pet godina) smanjenje mikroalbuminurije iznosilo 15%, pto je me.utim i dalje bilo statistiËki znaËajno. Ovi rezultati su konzistentni i vrlo sliËni rezultatima u DAIS i FIELD studijama11,12. Sekundarni ciljni ishod (periferna neuropatija zajedno s nefropatijom i retinopatijom) registriran je kod 38,2% ispitanika u skupini intezivnog lijeËenja i 40% ispitanika standardne skupine. Ako se promatra samo rezultat praÊenja periferne neuropatije i to po standardnoj “Michigen neuropathy screening score (MNSI)” ljestvici >2,0, onda je ona bila manje zabiljeæena u skupini intenzivne glukoregulacije nego standardnoj skupini (55,6% naspram 58,6%). Gubitak tetivno-mipiÊnih refleksa i osjeta finog dodira su bili rje.i u skupini intenzivne glokoregulacije na kraju studije, ali gubitak osjeta vibracije se nije razlikovao me.u skupinama. ZakljuËimo osvrt na rezultate ACCORD studije i analize podstudija rijeËima dr Barbare EK Klein s University of Wisconsin: “Ne vjerujem da Êe iskustva proizipla iz ACCORD studije dovesti kliniËare u dvojbu o vaænosti kontrole glikemije u prevenciji mikrovaskularnih komplikacija kod dijabetiËara. MoguÊe je ipak, da je reæim lijeËenja primijenjen u ACCORD studiji bio preagresivan, za razliku od razboritog pristupa kojim uobiËajeno pristupamo dijabetiËarima tip 2 s povipenim rizikom za krvoæilne pobole. No, vrlo je vaæno da rezultati ACCORD studije ne budu tendenciozno interpretirani, kako se ne bi vratili u lopu kontrolu glikemije. kao pto je primjerice bilo prije objave rezultata studije UKPDS”.13-15 Received: 25th Nov 2010 *Address for correspondence: Poliklinika za prevenciju kardiovaskularnih bolesti i rehabilitaciju, DrapkoviÊeva 13, HR-10000 Zagreb, Croatia; Phone: +385-1-4612-290; E-mail: goran.krstacic@zg.t-com.hr Literature >3.3mg/dL or a need for photocoagulation of retina or vitrectomy) was recorded in 556 patients in the intensive versus 586 in the standard group of treatment of totally 5.119 examinees10. Microvascular renal complications based on the analysis of urine indicated significant reduction of microalbuminuria in the group undergoing intensive treatment of glucoregulation. The reduction of albuminuria of 21% in the stage of transition of the study (after 3.5 years of follow-up) was recorded, while at the end of the study (5 years) the reduction of microalbuminuria was 15%, which was still statistically significant. These results are consistent and very similar to results in DAIS and FIELD studies11,12. The secondary target outcome (peripheral neuropathy together with nephropathy and retinopathy) was recorded in 38.2% examinees in the group undergoing intensive treatment and 40% of examinees undergoing standard treatment. If we only consider the screening score of peripheral neuropathy according to the standard “Michigen neuropathy screening score (MNSI)” scale >2.0, then it was less recorded in the group undergoing intensive glucoregulation than in the group undergoing standard glucoregulation (55.6% vs. 58.6%). The loss of tendon and muscular reflexes and fine touch sense were rarer in the group undergoing intensive glucoregulation at the end of the study, but the loss of vibration sense did not differ among the groups. Let us make a review of the results of the ACCORD study and analysis of sub-studies using the words of Dr Barbara EK Klein from the University of Wisconsin: “I do not think that the experiences gained in the ACCORD study make the clinicians question the importance of controlling glycemia in prevention of microvascular complications in diabetics. Nevertheless, it is possible that the treatment regime applied in the ACCORD study was too aggressive, unlike the rational approach that we usually apply for approaching diabetics type 2 with increased risk of cardiovascular diseases. However, it is very important that the results of the ACCORD study should not be tendentiously interpreted as to prevent bad control of glycemia which occurred prior to the publication of results of the study UKPDS”.13-15 1. KrstaËiÊ G, Reiner Æ. Inicijativa za smanjenje ostatnog rizika (R3i): Prvi sastanak nacionalnih predavaËa. Kardio list. 2009:4(8-9):67-9. 2. Fruchart JC, Sacks F, Hermans MP, Assmann G, Brown WV, Ceska R, et al. The Residual Risk Reduction Initiative: a call to action to reduce residual vascular risk in patients with dyslipidemia. Am J Cardiol. 2008;102(10 Suppl):1K-34K. 3. Fruchart JC, Sacks F, Hermans MP, Assmann G, Brown WV, Ceska R, et al for the Residual Risk Reduction Initiative (R3I). The Residual Risk Reduction Initiative: a call to action to reduce residual vascular risk in dyslipidaemic patient. Diab Vasc Dis Res. 2008;5:319-35. 4. The ACCORD Study Group. N Engl J Med. 2010;doi:10.1056/NEJMoa1001288. 5. The ACCORD Study Group. Effects of intensive glucose lowering therapy in type 2 diabetes mellitus. N Engl J Med. 2008;358:2545-59. 6. The ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362:1575-85. 7. The ACCORD investigators. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med. 2010;362:1563-74. 8. Nilsson PM. ACCORD and risk-factor control in type 2 diabetes. N Engl J Med. 2010;362:1628-30. 9. The ACCORD Study Group and ACCORD Eye Study Group. Effects of medical therapies on retinopathy progression in type 2 diabetes. N Engl J Med. 2010; 363:233-244. 10. Nichols GA. Closer Look at ACCORD’s Microvascular Outcomes. http://www.medscape.com/viewarticle/729745 (25.11.2010) 11. Keech AC, Mitchell P, Summanen PA, O’Day J, Davis TME, Moffitt MS, et al for the FIELD study investigators. Effect of fenofibrate on the need for laser treatment for diabetic retinopathy (FIELD study): a randomised controlled trial. Lancet. 2007;370:1687-97. 12. Steiner G. The Diabetes Atherosclerosis Intervention Study (DAIS): a study conducted in cooperation with the World Health Organization. Diabetologia. 1996;39:1655-61. 13. UK Prospective Diabetes Study Group: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837-53. 14. UK Prospective Diabetes Study Group: Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352:854-65. 15. UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38). BMJ. 1998;317:703-13. 2010;5(12):299. StruËni rad Professional article 2010;5(12):299. StruËni rad Professional article LSrËane bolesti u djelu Amatusa Lusitanusa, dubrovaËkog lijeËnikaXVI. stoljeÊa Cardiac diseases in the writtings of Amatususitanus, the 16th century Dubrovnik physician Antun Car* OpÊa bolnica Dubrovnik, Dubrovnik, Hrvatska Dubrovnik General Hospital, Dubrovnik, Croatia SAÆETAK: Povijest medicine u Dubrovniku predstavlja najslavnije poglavlje u zdravstvenoj kulturi hrvatskog naroda. DubrovËani su 1377. uveli prvu karantenu, 1306. leprozarij, 1317. prvu ljekarnu, a 1347. godine osnovana je prva bolnica. Dubrovnik je postao i mjesto dolaska brojnih stranih lijeËnika. Me.u njima najslavniji je bio Amatus Lusitanus koji je tri godine æivio u ovom gradu i u VI. centuriji svoga djela “Curationum medicinalium Centuriae septem” opisao lijeËenje i srËanih bolesnika svojim osebujnim i za danas vrlo neobiËnim medicinskim postupcima. KLJU»NE RIJE»I: povijest medicine, Amatus Lusitanus, Dubrovnik. O O bala hrvatskog Jadrana bila je kroz stoljeÊa pod jakim utjecajem italskog tla, posebno u doba srednjevjekovlja, humanizma i renesanse jer je bila kolijevka i glavno æaripte postantiËke medicine i farmacije. DubrovaËka republika bila je pod jakim utjecajem samostanske medicine i farmacije sinova Sv. Benedikta, Monte Cassina1. Prisutan je i Salerno sa svojom medicinskom pkolom, a i prvi poznati lijeËnik koji je 1300. godine uzet u gradsku sluæbu u Dubrovniku bio je Mr. Riccardus iz Salerna. Medicinu toga vremena upotpunjavale su i odredbe iz Medicinskog edikta Fridriha II, kralja obiju Sicilija, a potom medicinskog znanja Bolonje, Pavije i Padove. Ljekarnica Male braÊe ima najduæi redoslijed svojih ljekarnika ito od 1317. ljekarnike s domaÊeg tla. Isprva se ljekarna bavila prodajom ljekovitih trava, a kasnije su se prodavali i pravi lijekovi. Godine 1681. ljekarna se premjepta u gornji klaustar, a 1901. premjeptena je iz prostora klauzure u prostor u kojem se i danas nalazi2. Samostansko ljekarniptvo osobice je cvalo od VI. do IX. stoljeÊa, utemeljeno na radovima Kasiodora i njegovimprijevodima grËkih medicinskih knjiga. Osnova je bila Dioskuridova knjiga o bilju, zatim djela Hipokrata i Galena. Biljke su Ëinile kroz stoljeÊa vaæni dio procesa lijeËenja, a mnoge su u narodnoj tradiciji ostale i danas. U dubrovaËkim samostanima lijeËilo se uglavnom uzgojenim ljekovitim biljkama u dijelu vrta, tzv. Herbarijumu, pto je bilo propisano jop od doba Karla Velikoga. Neke od biljaka koje i danas nalazimo u narodnom lijeËenju, sluæile su kao sastavni dio recepture samostanskih ljekarnika. U knjigama, Ëesto nazvanima, knjigama sekreta lijeËenja nalazese tajne prirode lijeËenja koje je Ëovjek stoljeÊima otkrivao. U tim knjigama sekret je sinonim za lijek. Propisivali su se ljekoviti pripravci u obliku voda, ulja, infuza, sirupa SUMMARY: The history of medicine in Dubrovnik is one of the most famous chapters in the health culture of the Croatian nation. In 1377 the Dubrovnik citizens introduced the first quarantine, in 1306 the leprosarium, in 1317 the first pharmacy and in 1347 the first hospital was founded. Dubrovnik became the place where many foreign physicians came. Amatus Lusitanus who lived for three years in this town was the most famous among them and in the VI chapter of his article “Curationum medicinalium Centuriae septem” he described the treatment of cardiac patients applying his specific and today very unusual medical procedures. KEYWORDS: history of medicine, Amatus Lusitanus, Dubrovnik. CITATION: Kardio list. 2010;5(12):299-301. T T he Croatian Adriatic coast was strongly influenced by the Italic region throughout centuries, especially in the middle ages, during the period of humanism and renaissance as it was the cradle and main center of post-antique medicine and pharmacy. The Dubrovnik Republic was strongly influenced by the monastic medicine and pharmacy of the sons of St. Benedict, Monte Cassina1. Salerno with its school of medicine was also present, the first famous physician who was in 1300 employed by the town of Dubrovnik was Mr. Riccardus from Salerno. The medicine of these times was complemented by the provisions from the Medical edict Frederick II, the king of the both towns of Sicilia, and later by the medical knowledge of Boulogne, Pavia and Padova. The Little Brothers pharmacy has the longest sequence of pharmacists and from 1317 there were local pharmacists present. At first the pharmacy engaged in selling medicinal herbs, and later they sold real medicines. In 1681, the pharmacy was relocated to upper cloister, while in 1901 it was relocated from the premises of the cloister to the premises where it is located nowadays2. The monastic pharmacy flourished from 6th till 9th century, based on the articles of Kasiodor and his translations of Greek books of medicine. The basis was the Dioskurid’s book of herbs then the papers of Hippocrates and Galen. The herbs were an important part of the treatment process throughout centuries, and many remained as a part of the national treatment tradition even nowadays. In the Dubrovnik monasteries people were treated mainly by cultivated herbs in a part of the garden, the so called Herbarium which was prescribed since the age of Carlo the Great. Some of the herbs that we still today may find in the indigenous treatment were used as an integral part of the recipes of monastery pharmacists. In the book often called Books of Secrets for Treatment, there are secrets of the nature of 2010;5(12):300. 2010;5(12):300. i masti. Pred Kneæevim dvorom u ljekarni koja je tada tamo postojala, nalazio se inventar lijekova koji je godine 1553. pokazao brojne jednostavne lijekove zvane “simplicia” i sastavljene lijekove “composita”3. VeÊina jednostavnih lijekova su biljne naravi tako da tu me.u ostalima nalazimo Fructus anisi, Fr. datali, Lignum aloe, Lign. santali albi i rubri, Mandragoru, brojne aromatiËne droge, smole, ukru- Êene sokove, kao pto je Aloa i Opium. Composita su bila sastavljena od mnogo sastojaka, me.u njima izdvajam “Species dulces” koji su se nazivali “confectiones”. “Condita” su ukuhani vegetabilni dijelovi u peÊeru ili medu, ptosu kasnije radili slastiËari i od kojih je dopao poznati lijektoga doba, marcipan. “Sirupi” su se izra.ivali iz peÊera sladorne trstike i u tom starom inventaru se spominju S. Deupatorio, S. D’isopae, S. Di fumo terre i drugi. Kako su koriptene navedene trave i lijekovi u lijeËenjusaznaje se iz djela jednog od najveÊih lijeËnika staroga Dubrovnika, Æidova Amatus Lusitanusa. Amatus je bio ro. en 1511. u Portugalu, a umro u Solunu 1568. god. U Dubrovnik je dopao bjeæeÊi pred progonom Æidova jer se znalo da Grad osim svojeg domicilnog stanovniptva katoliËke vjeroispovijesti, prima jop samo Æidove4. Prije Dubrovnika radio je u Anconi, Pesaru, Rimu, a godina dolaska u Dubrovnik je prema izvorima 1556. U Italiji je slovio za odliËnog znanstvenika i lijeËnika pa je, kako je to Ëesto u napoj struci, bio metom napada zavidnih kolega. Nakon pto je Amatus ustvrdio grepke u prevo.enju i komentaru Dioskoridove knjige glasovitog lijeËnika i botaniËara PietraAndree Mathiolija, ovaj ga je napao nazivajuÊi ga “Amathus — neznalica”. Amatusov lijeËniËki rad u Dubrovniku opisan je u VI. centuriji njegovog djela “Curationum medicinalium Centuriae septem”. RijeË je uglavnom o lijeËenju DubrovËanaili pak njihovim gostima i ljudima koji su dolazili Ëak izdaleka da ih lijeËi Amatus. Zanimljivo je da je kod hemoroidalnih krvarenja stavljao pijavice na “straænje crijevo” i propisivao laksativ “decoctum rhabarbarum et tamarindorum”. PreporuËavao je koprivu kod krvarenja iz nosa ipluÊnih bolesti, a korijen perpina, radix petroselini davaokao diuretik. Veliki Amatus je jednome mladiÊu, kojemu je kod koitusa umjesto sperme izipao flatus “pto ga je veoma æalostilo” dao piper albus et niger, semen urticae i pyrethrum. Me.u stotinu razliËitih prikaza sluËajeva, kuracija, nalaze se i neki koji govore o dobrom poznavanju srËanihbolesti. Kuracija XXXIII. govori o lijeËenju dubrovaËkogvlastelina Pava GradiÊa koji je tada imao 47 godina. Nemapodataka na koji ga je naËin lijeËio, ali je postavio dijagnozu angine pektoris u kombinaciji s gihtom. “In qua agitur de dolore stomachi, cordis quoque regionem infestante, ab humore melancholoco et viscida pituita eveniente: simulque de podagra.” Amatus donosi i prvi poznati opis akutnog infarkta miokarda u nas. Bio je pozvan nekom opatu na otok Lokrum koji se tuæio na bolove u srcu i iznad srca i potom naglo izgubio svijest i umro. Amatus je, da bi dokazao smrt, stavio svijeÊu pred nos umrloga, zrcalo pred usta i Ëapu vode na grudi. Potom je obznanio dabolesnik, po svemu sudeÊi nije umro od apopleksije, negood koronarne tromboze. Sliku srËanog popuptanja donosiAmatus u sluËaju æene turskog poglavara iz Herceg Novog (uxor Eminii Neocastrensis) koja je imala 50 godina. “Bilaje debela i troma, ruke, noge i vje.e bile su joj oteËene” i treatment that the man had been discovering for centuries. In such books a secret is a synonym for a medicine. Different healing agents in form of water, oil, infusion, syrup and fat were prescribed. In front of Kneæev dvor in the pharmacy that existed there at that time there was an inventory of medicines that in 1553 showed a number of simple medicines called “simplicia” and complex medicines called “composita”3. The majority of simple medicines were herbal medicines and there are some of them like Fructus anisi, Fr. datali, Lignum aloe, Lign. santali albi and rubri, Mandragoru, a great number of aromatic drugs, resins, hardened juices, such as Aloa and Opium. Composita were composed of many ingredients, some of them are “Species dulces” that they called “confectiones”. “Condita” are cooked vegetable parts in sugar or honey, later prepared by confectioners who are famous for well-known medicine that from that period comes known as marzipan. “Syrups” were made from sugar of sugar cane and this old inventory includes some names mentioned such as S. Deupatorio, S. D’isopae, S. Di fumo terre and other. The method how the above herbs and medicines were used in treatment is shown in the paper of one of the greatest physicians of old Dubrovnik, the Jew Amatus Lusitanus. Amatus was born in 1511 in Portugal and he died in Solun in 1568. He came to Dubrovnik fleeing during the time of Jew-baiting because it was known that besides its domicile citizens of Catholic religion, the Town was receiving only Jews4. Before coming to Dubrovnik, he worked in Ancona, Pesar, Rome, and according to historical resources, he came to Dubrovnik in 1556. In Italy, he was known as a renowned scientist and physician and this is the reason why he was the “target of attacks by envious colleagues” as this often occurs in our profession. After Amatus had determined errors in translation and comment of the Dioskorid’s book of the famous physician and botanist Pieter Andrea Mathioli, the latter called him “Amathus — a nitwit”. The work of Amatus as a physician in Dubrovnik was described in the VI chapter of his paper “Curationum medicinalium Centuriae septem”. It was about the treatment of the Dubrovnik citizens or their guests and people who came from distant places to be treated by Amatus. It is interesting that in case of bleeding from hemorrhoids he put leeches on the “rear bowl” and prescribed laxative “decoctum rhabarbarum et tamarindorum”. He recommended nettles in case of nose bleeding and pulmonary diseases, while he administered the parsley root, petroselini radix as a diuretic. Great Amatus administered piper albus et niger, semen urticae and pyrethrum to one young man who complained about release of flatus instead of sperm during coitus “which made him feel very sad”. Among some 100 different presentations of the case of “curations” there are some presentations which suggest some good knowledge of cardiac diseases. The XXXVIIICuration speaks about the treatment of Pavo GradiÊ, the Dubrovnik landowner who was 47 years old at that time. There is no data about how he was treated, but he was diagnosed angina pectoris combined with gout. “In qua agitur de dolore stomachi, cordis quoque regionem infestante, ab humore melancholoco et viscida pituita eveniente: simulque de podagra.” Amatus presents the first known description of acute myocardial infarction in our country. He was invited by some abbot who complained about pains in the heart and above heart and then suddenly lost conscience and died. Amatus put a candle in front of the nose, a mirror in front of the mouth and put a glass of water on 2010;5(12):301. zakljuËuje da je umrla od “hydropsa” zbog popuptanja sr-the chest to prove his death. Afterwards, he made it known ca. that the patient obviously did not die of stroke, but of coro- U to doba Dubrovnikom je, kao i ostalim europskimgradovima, vladala i zaraza luesom. Prikaz luetiËkog miokarditisa Amatus donosi kod jop jednog dubrovaËkog vlastelina Jakova BasiljeviÊa, koji je imao 45 godina. Prije obraÊanja Amatusu za pomoÊ bolovao je od luesa i oteËenihoËnih kapaka, a potom je dobio visoku temperaturu. “Nakon svakih 4 do 5 pulzacija, puls mu izostaje, nakon Ëega slijede dvije pulzacije.” Amatus smatra da je to stanjeopasnije kod mladiÊa nego kod djece i dræi da nastaje zbog toga pto “lopi sokovi komprimiraju arteriju.” PreporuËio je jaËanje srca, puptanje krvi i purgancija. U dekurzusu je opisao da je pacijent bio prvo “heterorhythmus, potom pararhythmus i konaËno eurhythmus” te zakljuËujeda se radilo o myocarditis luetica. SluËajevi luesa su u patricijskim krugovima bili razmjerno Ëesti. U lijeËenju luesa Amatus je koristio kure mazanjem æivom te napitke radix chinae, lignum guajaci i radix sarsaparillae. Amatus Lusitanus je u Dubrovniku proveo samo tri go- dine ali, kako povjesniËari toga doba tvrde, DubrovËaninikada prije nisu imali lijeËnika koji je po svojoj spremi i po sposobnostima bio ravan Amatusu. Received: 21th Nov 2010 *Address for correspondence: OpÊa bolnica Dubrovnik, Dr. Roka MipetiÊa 2, HR-20000 Dubrovnik, Croatia E-mail: antunc@bolnica-du.hr Phone: +385-20-431-777 Fax: +385-20-426-149 Literature nary thrombosis. The cardiac failure was presented by Amatus in the case of the Turkish principal’s wife from Herceg Novi (uxor Eminii Neocastrensis) who was 50 years old. “She was fat and sluggish, her hands, legs and eyelids were swollen” and he concludes that she died of “hydrops” as a consequence of heart failure. At that time the region was just like the other European towns affected by the infection lues. The luetic myocarditis was diagnosed by Amatus in another Dubrovnik landowner, Jakov BasiljeviÊ who was 45 years old. Before he asked Amatus for help, he had been suffering from lues and swollen eyelids followed by high temperature. “Following every 4-5 pulsations, the pulse lacked, followed by the two pulsations.” Amatus thinks that this condition is more dangerous for young people than for children, and thinks that is occurs because “bad juices compromise the artery”. He suggested strengthening of heart, blood letting and purgation. In the decursus he described that the patient was first “heterorhythmus, after that pararhythmus and finally eurhythmus” and concludes that myocarditis luetica was concerned. The cases of lues were rather frequent in patrician circles. In the treatment of lues, Amatus used the cures by covering the mercury over the body and using drinks radix chinae, lignum guajaci and radix sarsaparillae. Amatus Lusitanus spent only three years in Dubrovnik, but as the historians living in that age claim the Dubrovnik citizens had never had a physician who was equal to Amatus judging by profession and abilities. 1. GrdiniÊ V. Ljekarniptvo na tlu Hrvatske. Zagreb: Nakladni zavod Matice hrvatske, 1996. 2. VelniÊ V. Knjiga sekreta don Aleksija Piemonteza. Farmakolopki glasnik. 1973;2:43-52. 3. KesterËanek Z. O inventarima dubrovaËkih ljekarna u XVI. stoljeÊu. Zbornik lijeËnika Hrvatske, 1954. 4. Glesinger L. Amatus Lusitanus i njegov lijeËniËki rad u Dubrovniku. Zagreb: Biblioteka Jevrejskog narodnog kalendara, 1940. Nakladnik i izdavaË / Editing and publishing company: Hrvatsko kardiolopko druptvo / Croatian Cardiac Society • Adresa / Address: KippatiÊeva 12, 10000 Zagreb, Croatia • Telefon /Phone: +385-1-2388-888 • Za nakladnika / For Publisher: Davor MiliËiÊ (HR) • Glavni urednik / Editor-in-Chief: Mario Ivanupa (HR) • UredniËki odbor / Editorial Board: Zdravko BabiÊ, Æeljko BariËeviÊ, Antun Car, Maja »ikep, Viktor »uliÊ, Dupka Glavap, Irena Ivanac, Mario Ivanupa, Goran KrstaËiÊ, Jana Ljubas, Æeljko Madæar, Goran MiliËeviÊ, Viktor PerpiÊ, –eiti PrvuloviÊ, Robert Steiner, Vedran VelagiÊ i Hrvoje VraæiÊ • Savjet / Advisory Board: Mijo Bergovec (HR) , Bojan JelakoviÊ (HR) , Æarko MavriÊ (HR) , Davor MiliËiÊ (HR) , Jure Mirat (HR) , Vjeran NikoliÊ-Heitzler (HR) , Dubravko PetraË (HR) , Stojan PoliÊ (HR) , Æeljko Reiner (HR) i Luka ZaputoviÊ (HR) • TehniËki urednik / Technical Editor: Stjepan Horvat (HR) • E-mail: kardio@kardio.hr • URL: http://www.kardio.hr/kardio-list.html • Priprema i tisak / Editing prepared by: »VOR d.o.o., Matice hrvatske 24, Bjelovar, Croatia, Phone: +385-43-244-050, www.cvor.hr • Prijevod / Translated by Studium d.o.o. Phone: +3851- 3475-720 or +385-1-400-20-60 www.studium-jezici.hr or www.sudski-tumaci.com • Naklada / Print run: 1100 copies • Informacije o pretplati / Subscription info: Tiskano izdanje je besplatno za lijeËnike, a mreæno izdanje je u cijelosti dostupno svima. / Physicians can receive the print editions of Kardio list free of charge. Kardio list is open access journal with free and unrestricted access for all online readers. • Copyright: Hrvatsko kardiolopko druptvo / Croatian Cardiac Society. ISSN: 1846-0836 (tiskano izdanje / printed edition) • ISSN: 1846-3231 (mreæno izdanje / online edition) • •• U UUD DDK KK/ //U UUD DDC CC 6 661 116 66. ..1 112 22( ((0 005 551 11) ))= ==1 116 664 44. ..4 442 22= ==1 111 111 11. .. Kardio list je indeksiran/ukljuËen u Katalogu Nacionalne i sveuËilipne knjiænice u Zagrebu, programu HINARI, bibliografskoj podatkovnoj bazi EMCare, Index Copernicus Journals Master List i Open J-Gate / Kardio list is indexed/listed in National and University Library Catalogue (Zagreb, Croatia), HINARI programme, bibliographic database EMCare, Index Copernicus Journals Master List, and Open J-Gate. »lanci su kategorizirani prema “Uputama za uredniptva Ëasopisa” koji su dostupni na portalu HrËak / The articles are categorized according to “Instructions for journal editorial boards” available at the HrËak web site: http://hrcak.srce.hr/admin/upute.doc 2010;5(12):302. Ostalo Other 2010;5(12):302. Ostalo Other Zapisnik sa sjednice Minutes of the Meeting of the Upravnog odbora Hrvatskog Croatian Caradiac Society kardiolopkog druptva Management Board on 12. listopada 2010. 12th October 2010 Darko PoËaniÊ* Hrvatsko kardiolopko druptvo, tajnik Croatian Cardiac Society, Secretary Sjednica Upravnog odbora (UO) Hrvatskog kardiolo-The Management Board (MB) meeting of the Croatian pkog druptva (HKD) odræana je 12. listopada 2010. godineCardiac Society (CCS) was held on 12th October 2010 at 17 u 17,00 sati u VijeÊnici Medicinskog fakulteta u Zagrebu. o’clock in the main hall of the Faculty of Medicine in Za greb. NazoËni: The attendees: 1. Prof. dr. sc. Davor MiliËiÊ, predsjednik d.milicic@mail.inet.hr 2. Prof. dr. sc. Mijo Bergovec, dopredsjednik mijo.bergovec@usa.net 3. Dr. Darko PoËaniÊ, tajnik dpocanic@gmail.com 4. Mr. sc. Eduard MargetiÊ, rizniËar eduard.margetic@gmail.com 5. Doc. dr. sc. Maja Strozzi maja.strozzi@zg.t-com.hr 6. Prof. dr. sc. Luka ZaputoviÊ lukaz@medri.hr 7. Prof. dr. sc. Josip Vincelj jvincelj@kbd.hr 8. Doc. dr. sc. Viktor PerpiÊ viktor.persic@ri.t-com.hr 9. Dr. Mladen JukiÊ mladen.jukic@sunce.hr Unaprijed se ispriËao da je sprijeËen doÊi: The following persons announced their absence in advance: 1. Doc. dr. sc. Robert Steiner Na sastanku je potvr.en dnevni red: The following agenda was verified at the meeting: 1. PrihvaÊanje zapisnika prethodne sjednice UO 18. 1. Adoption of the minutes of the previous meeting of lipnja 2010. the Management Board of 18th June 2010 2. Introducing the program of the 8th Congress of the 2. Upoznavanje s programom 8. kongresa Hrvatskog Croatian Cardiac Society kardiolopkog druptva 3. Preparation for the Elective General Assembly that 3. Pripreme za Izbornu skupptinu koja Êe se odræati ti- will be held during the Congress jekom kongresa 4. Report by Prof. MiliËiÊ of the Croatian Heart House 4. IzvjepÊe prof. MiliËiÊa o Hrvatskoj kuÊi srca 5. Report by Prof. ZaputoviÊ of the internal medicine 5. IzvjepÊe prof. ZaputoviÊa o programu specijalizacija and cardiology specialization program iz interne medicine i kardiologije 6. Miscellaneous 6. RazliËito Ad 1. The minutes of the previous meeting of the Management Board has been adopted. Ad 2. Prof. MiliËiÊ has thoroughly introduced the pro- Ad 1. Prodiskutiran je i prihvaÊen zapisnik s prethod gram of the forthcoming congress to the attendees. He es nog sastanka Upravnog odbora. pecially pointed out that Prof. M. Komajda, Prof. P.E. Var- Ad 2. Prof. MiliËiÊ je podrobno upoznao nazoËne s das, Prof. T. Gillebert, Prof. M.F.Kenda, who are doyens of programom predstojeÊeg konrgesa. Posebno je naglasio the European cardiac profession, will be present at the ceremonial opening. He also mentioned that they accepted kako Êe na sveËanom otvaranju biti nazoËni prof. M. Ko the invitation to be present at our Congress, although na majda, prof. P.E. Vardas, prof. T. Gillebert, prof. M.F. Ken tional congresses in Greece and Turkey will be held at the da, koji su doajeni europske kardiolopke struke. Pri tome je same time. During the ceremony of opening of the Con naglasio kako su prihvatili poziv da budu nazoËni na na gress, following the plenary lectures, the ceremonial propem kongresu, mada se istodobno odræavaju nacionalni clamation of honorable members of the Croatian Cardiac kongresi u GrËkoj i Turskoj. Tijekom sveËanosti otvorenja Society will take place. kongresa, nakon plenarnih predavanja, bit Êe sveËano pro-The program of called lectures, oral presentations andglapenje poËasnih Ëlanova Hrvatskog kardiolopkog druptva. satellite symposiums by days will be thoroughly analyzed 2010;5(12):303. Nakon toga je temeljito analiziran program pozvanih afterwards. During the discussion about professional abpredavanja, oralnih prezentacija i satelitskih simpozija postracts that will be presented on posters, Prof. Bergovecdanima. Tijekom rasprave o struËnim radovima koji Êe se pointed out the importance of presentation of the poster izlagati putem postera, prof. Bergovec je naglasio kako jeaccompanied by the author’s short discussion during the vaæno da prezentacije postera budu praÊene kratkom ras-presentation. It has been decided that three best profespravom autora u vrijeme prikaza. OdluËeno je i da Êe sesional abstracts will be selected among oral and poster pre izabrati tri najbolja struËna rada me.u oralnim i poster sentations, whose authors are younger internal medicine and/or cardiology residents, not over 40 years of age. The prezentacijama, kojima su autori mla.i specijalizanti in- Commission for the evaluation of abstracts has been imme terne i/ili kardiologije, ne stariji od 40 godina. Odmah je diately established and it will consist of present members ustanovljena komisija za ocjenu radova, koja Êe se sasto of the MB, so every person will evaluate one group of ab jati od nazoËnih Ëlanova UO, tako da Êe svaki ocijeniti stracts by days. Afterwards, the three best abstracts from jednu skupinu radova, po danima. Nakon toga Êe predloæi their groups will be selected and then every member of the ti tri najbolja rada iz svoje skupine te Êe potom svaki od MB will vote on proposed papers, granting credits for the Ëlanova UO glasati o predloæenim radovima, dajuÊi im bo papers (proposal of Prof. ZaputoviÊ, that is accepted unan dove (prijedlog prof. ZaputoviÊa, koji je prihvaÊen jedno imously — the combination of absolute and relative selec glasno — kombinacija apsolutnog i relativnog izbora). Tri tion). The three papers with the greatest number of credits rada s najvipe bodova bit Êe proglapeni prvim, drugim i tre will be proclaimed the first, second and third best paper. It Êim najboljim radom. Ustanovljeno je da Êe nagrada za has been established that the prize for the best poster will najbolji poster biti put i prisustvovanje na Europskom kon be taking part at the ESC Congress in 2011 in Paris, the segresu kardiologa 2011. godine u Parizu, druga nagrada put cond prize is the trip to and taking part at the Dubrovniki prisustvovanje na skupu Dubrovnik Highlights in Cardiol-Highlights in Cardiology in 2011 and the third prize will beogy 2011. godine, a treÊa nagrada je knjiga ESC Textbook ESC Textbook in Cardiology. in Cardiology. Ad 3. Prof. MiliËiÊ has suggested that a proposal for the Ad 3. Prof. MiliËiÊ je predloæio da se na izbornoj skup-President, Vice-President, Members of the Managementptini, koja Êe se odræati u subotu, 23. listopada, pripremiand Supervisory Board and Ethics Committee should be prijedlog za predsjednika, dopredsjednika, Ëlanove Uprav-prepared at the Elective General Assembly that will be held nog i Nadzornog odbora te EtiËkog povjerenstva. Nakonon Saturday, 23rd October. Following the presentation of prezentacije prijedloga moguÊa je popuna liste kandidatathe proposal, a list of candidates may be completed (accor( prema Statutu druptva, svaki punopravni Ëlan HKD moæeding to the Statutes of the Society, every full member of predloæiti bilo koga od Ëlanova za ova tijela). Potom Êe se CCS may propose any of these members for these bodies). The voting will start afterwards. Dr. PoËaniÊ has suggested pristupiti glasovanju. Dr. PoËaniÊ je predloæio da se izbjeg that unnecessary waste of time should be avoided at the ne nepotrebno gubljenje vremena prilikom prebrojavanja time of counting the members, so that the inspection Ëlanova, da se odmah na ulazu vrpi provjera i biljeæenje should be performed and registration of the members dur- Ëlanova dok pristupaju u dvoranu, tako da Êe se znati broj ing entering the hall should be done at the entrance door. Ëlanova i ustanoviti postojanje kvoruma, pto je bitno da bi This is how the number of members will be known and izbori bili valjani. Za tu priliku tajnik dr. PoËaniÊ Êe pri how the quorum will be determined, which is important, premiti ispis aktualnog popisa Ëlanova. Na taj naËin neÊe so that the elections may be valid. On that occasion, the se omoguÊiti osobama koje nisu Ëlanovi niti prisustvovan- Secretary Dr. PoËaniÊ will prepare the printout of actual list je izborima. Prijedlog je jednoglasno prihvaÊen. of members. This is the way how the persons who are not the members will be prevented from taking part in the elections. The proposal has been unanimously accepted. Kao kandidati su predloæeni: The following candidates have been proposed: Predsjednik / President: Prof. dr. sc. Davor MiliËiÊ, dr. med. Dopredsjednik / Vice-President: Prof. dr. sc. Mijo Bergovec, dr. med. Upravni odbor / Management Board: Doc. dr. sc. Maja Strozzi, dr. med. Mladen JukiÊ, dr. med. Hrvoje StipiÊ, dr. med. Doc. dr. sc. Ivo VukoviÊ, dr. med. Prof. dr. sc. Luka ZaputoviÊ, dr. med. Doc. dr. sc. Robert Steiner, dr. med. Doc. dr. sc. Viktor PerpiÊ, dr. med. Prof. dr. sc. Josip Vincelj, dr. med. Doc. dr. sc. Dijana DeliÊ BrkljaËiÊ, dr. med. Nadzorni odbor / Supervisory Board: Prof. dr. sc. Jure Mirat, dr. med. Pejo SamardæiÊ, dr. med. Prim. Vojtjeh Brida, dr. med. Doc. dr. sc. Martina LovriÊ BenËiÊ, dr. med. Mr. sc. prim. Mirjana Jembrek GostoviÊ, dr. med. 2010;5(12):304. 2010;5(12):304. EtiËki odbor / Ethics Committee: Prof. dr. sc. Vladimir Goldner, dr. med. Akademik Ivo »ikep Prof. dr. sc. ©ime Mihatov, dr. med. Prof. dr. sc. Drago RakiÊ, dr. med. Dr. sc. prim. Mario Ivanupa, dr. med. Za vo.enje skupptine predloæeni su / The proposed persons for running the Assembly are: Doc. dr. sc. Robert Bernat — Predsjednik izborne skupptineDoc. dr. sc. Diana DeliÊ BrkljaËiÊDoc. dr. sc. Alen RuæiÊ Za Ëlanove izbornog povjerenstva predloæeni su / The proposed members of the Election Committee are: Dr. Marijan Padovan — Predsjednik izbornog povjerenstva Mr.sc. Eduard MargetiÊ Dr. sc. Maja »ikep Predloæeni predsjednik i dopredsjednik odluËili su da, ukoliko budu izabrani u sljedeÊi mandat, predloæe za tajnika dr. Darka PoËaniÊa i za rizniËara mr. sc. Eduarda MargetiÊa, jer se UO jednoglasno pozitivno izjasnio od njihovom radu u proteklom mandatu. Naglapeno je da je druptvo i organizacijski i financijski, s aspekta prikupljanja Ëlanarina, zaæivjelo u punom smislu u proteklom mandatnom sastavu. Ad 4. Prof. MiliËiÊ je izvijestio nazoËne o realizacijiprojekta “Hrvatska kuÊa srca”, koji je u zavrpnoj fazi. Naime, dan prije sastanka UO dobio je informaciju da je odobren prostor u Oktogonu, na III. katu, koji Êemo moÊi uskoro koristiti i urediti prema napim potrebama. Tako je sretno okonËana aktivnost osnivanja zaklade koja je trajala vipe od tri godine. Prostor Êemo dijeliti s udrugom ZagrebaËkih branitelja Vukovara. Prof. MiliËiÊ je naglasio da je prostor u vrlo dobrom stanju i reprezentativan, pto je izazvaloodobravanje svih nazoËnih. Ad 5. Prof. ZaputoviÊ je izvijestio da su, prema njegovim saznanjima, konaËno upuÊene na provedbu smjernice za novi program svih specijalizacija, usuglapen sa standardima EU, pto posebice znaËi puno za napu struku. Ostajeza vidjeti kada Êe program zaæivjeti, jer su prof. MiliËiÊ i prof. Bergovec naglasili da su na njihovim klinikama upravo zapoËeli sa specijalizacijom lijeËnici po starom programu. Ad 6. Prof. Bergovec je izvijestio nazoËne kako je pozvan na sastanak Europskog povjerenstva za izradu smjernica, kao nacionalni koordinator, u European Heart House u Sophia Antipolis 2. prosinca i 16. i 17. prosinca, gdje Êe biti hrvatski predstavnik izrade i koordiniranja primjene europskih smjernica u kardiologiji. Dr. PoËaniÊ je upoznao nazoËne s problemom odræavanja dva skupa HKD u isto vrijeme od 25. do 27. oæujka 2011. godine: 12. simpozij o aritmijama i elektrostimulaciji srca u Zagrebu i 4th National Meeting on Interventional Cardiology @ Fellow Course Radne skupine za intervencijsku kardiologiju u Dubrovniku. Kako je potonji skup ranije najavljen i veÊ oglapen na web-u, nazoËni su bili mipljenja da se ne moæe mijenjati termin odræavanja u Dubrovniku te skup koji traje jedan dan u Zagrebu (Simpozij oaritmijama) treba pokupati promijeniti satnicu, o Ëemu valja obavijestiti Predsjednika radne skupine prof. PetraËa. Dr. PoËaniÊ je predloæio da se prilikom registracije na kongresu obveæe sve sudionike da ispune registracijski lis- The proposed President and Vice-President decided toselect Dr. Darko PoËaniÊ as the Secretary and M.Sc. Eduard MargetiÊ as the Treasurer on condition that they are elected for the next term of office, because the MB unanimously positively evaluated their work during the previous term of office. It has been emphasized that the Society has improved financially and in terms of organization with regard to collecting membership fees during the previous term of office. Ad 4. Prof. MiliËiÊ has informed the attendees about the implementation of the project “Croatian Heart House” which is in the final stage. The day prior to the meeting, the MB received the information about the approval for giving the premises in Oktogon on the third floor that we may use and refurnish according to our requirements. This is how the activity of establishment of the Foundation that had lasted for three years was successfully completed. We shall share the premises with the Zagreb Association of theVukovar Defenders. Prof. MiliËiÊ has emphasized that the premises are in very good condition and of high quality, which was welcomed by all attendees. Ad 5. Prof. ZaputoviÊ has informed that according to information made available to him, the guidelines for the new program of all specializations have been sent for enforcement, which have been complied with the EU standards, which means a lot for our profession. We shall see when the program will be implemented, because Prof. MiliËiÊ and Prof. Bergovec said that physicians at their clinics had just started the specialization based on the previous program. Ad 6. Prof. Bergovec has informed the attendees that he has been invited to the meeting of the European Committee to the European Heart House in Sophia Antipolis for the preparation of the guidelines, acting in capacity as National Coordinator, on 2nd December and from 16-17 December, where the Croatian representative will be present for the preparation and coordination of the application of the European guidelines in Cardiology. Dr. PoËaniÊ has made the attendees familiar with the problem of holding two HKD meetings at the same time from 25 to 27 March 2011: 12th Symposium of Arrhythmia and Heart Electrostimulation in Zagreb and 4th National Meeting on Interventional Cardiology @ Fellow Course in Dubrovnik. Since the latter meeting was announced earlier and advertized on the web site, the attendees thought that the term of holding the meeting in Dubrovnik should not be rescheduled and the term of meeting that lasts for only one day in Zagreb (Symposium of Arrhythmia) should 2010;5(12):305. tiÊ s podrobnim podacima, napose s adresama elektroniËke popte kako bi se komunikacija me.u Ëlanstvom uspostavila skuladno 21. stoljeÊu. Prijedlog je jednoglasno prihvaÊen, a prof. MiliËiÊ je predloæio da agencija Spektar vodi o tome raËuna prilikom prijave sudionika. Na koncu su se svi nazoËni sa zadovoljstvom osvrnuli na rad Predsjednika, Dopredsjednika i Upravnog odbora uproteklom mandatnom razdoblju. OpÊa je ocjena da je druptvo funkcioniralo bolje nego ikada ranije. SljedeÊi sastanak UO zakazat Êe novoizabrani predsjednik, dopredsjednik i Upravni odbor. Sastanak je zavrpen u 19,45 sati. Received: 19th Oct 2010 *Address for correspondence: KliniËka bolnica Merkur, ZajËeva 19, HR-10000 Zagreb, Croatia; Phone: +385-1-2431-390; E-mail: dpocanic@gmail.com be rescheduled and Prof. PetraË who is the President of the Working Group should be notified about this rescheduled term. Dr. PoËaniÊ has suggested that all participants should be obligated to fill in the registration form with all required details at the time of registration at the Congress, thereby especially entering the e-mail addresses, so that the communication among members may be established according to the 21st century rules. The proposal has been unanimously accepted and Prof. MiliËiÊ has suggested that the Agency Spektar should be charged with that task at the time of application of the participants. Finally, all attendees express their satisfaction with the work of President, Vice-President, MB during the former term of office. They generally estimated that the Society functioned better than ever. The next meeting of the MB will be convened by president, Vice-President and the MB. The meeting ended at 19.45 o’clock. Ostalo Other Zapisnik s Izborne skupptine Hrvatskoga kardiolopkog druptva Opatija, hotel Ambasador 23. listopada 2010. godine N N akon pto je utvr.ena nazoËnost 160 redovitih Ëlanova Hrvatskoga kardiolopkog druptva (HKD) skupptina je zapoËela s radom. Predsjednik druptva prof. MiliËiÊ je na poËetku dao rijeË tajniku HKD-a dr. PoËaniÊu koji je predloæio radno predsjedniptvo u sastavu: doc. Bernat, doc. DeliÊ BrkljaËiÊ i doc. RuæiÊ, za izborno povjerenstvo dr. Padovan, dr. MargetiÊ i dr. Maja »ikep, za zapisni- Ëara dr. Jopko Bulum i za ovjerovitelje zapisnika prim. Raos i prim. Ivanupa. Prijedlog je stavljen na glasovanje ijednoglasno prihvaÊen nakon Ëega je dr. PoËaniÊ u imeUpravnog odbora HKD-a proËitao popis predloæenih kandidata za tijela HKD-a: Minutes of the Elective Assembly of the Croatian Cardiac Society Opatija, the hotel Ambasador 23rd October 2010 A A fter the presence of 160 ordinary members of the Croatian Cardiac Society (CCS) was determined, the Assemblystarted its work. President of the CCS Prof. MiliËiÊ has at the beginning given a word to the Secretary to CCS Dr. PoËaniÊ that suggested the Chairpersons consisting of: Ass. Prof. Bernat, Ass. Prof. DeliÊ BrkljaËiÊ and Ass. Prof. RuæiÊ, forthe Elective committee Dr. Padovan, Dr. MargetiÊ and Dr. Maja »ikep, Dr. Jopko Bulum for Keeper of Minutes and Head Dr. Raos and Head Dr. Ivanupa as the Certifiers of Minutes. The proposal has been put to vote and has been unanimouslyadopted after which Dr. PoËaniÊ has in the name of the CCS Management Board (MB) read out the list of proposed candidates for the CCS bodies: 1. ZA PREDSJEDNIKA / FOR THE PRESIDENT: prof. dr. Davor MiliËiÊ 2. ZA DOPREDSJEDNIKA / FOR VICE-PRESIDENT : prof. dr. Mijo Bergovec 3. ZA UPRAVNI ODBOR / FOR THE MANAGEMENT BOARD: doc. dr. Maja Strozzi, dr. Mladen JukiÊ, dr. Hrvoje StipiÊ, prof. dr. Luka ZaputoviÊ, doc. dr. Ivica VukoviÊ, doc. dr. Robert Steiner, doc. dr. Viktor PerpiÊ, prof. dr. Josip Vincelj i doc. dr. Diana DeliÊ BrkljaËiÊ. 4. ZA NADZORNI ODBOR / FOR THE SUPERVISORY BOARD: prof. dr. Jure Mirat, dr. Pejo SamardæiÊ, prim. dr. Vojtjeh Brida, prof. dr. Martina LovriÊ BenËiÊ i prim dr. Mirjana Jembrek GostoviÊ. 5. ZA ETI»KO POVJERENSTVO / FOR THE ETHICS COMMITTEE: akademik Vladimir Goldner, akademik Ivo »ikep, prof. dr. ©ime Mihatov, prof. dr. Drago RakiÊ i prim. dr. Mario Ivanupa. Pozvani su svi nazoËni redoviti Ëlanovi HKD-a da All present ordinary CCS members are called to propose predloæe svoje kandidate za navedena tijela i funkcije. their candidates for the indicated bodies and functions. Prva toËka dnevnog reda je bila izvjepÊe predsjednikaThe first item of the agenda was the report by the Presprof. MiliËiÊa o radu u proteklom mandatnom razdoblju.ident Prof. MiliËiÊ about his work during the previous termProf. MiliËiÊ je istaknuo kako je HKD u proteklom manda-of office. Prof. MiliËiÊ has emphasized that CCS was durtu bilo jedno od najaktivnijih struËnih medicinskih drupta-ing the previous term of office one of the most active exva u Hrvatskoj, jednom mjeseËno se sastajao Upravni od-pert medical societies in Croatia, once a month the MB of 2010;5(12):306. 2010;5(12):306. bor druptva s dostupnim zapisnikom sastanka objavljenim na web portalu druptva i u Kardio listu, Radna skupina (RS) za aritmije je organizirala 2 skupa u Zagrebu, RS za bolesti srËanih zalistaka je organizirala skup u Hrvatskom lijeËniËkom zboru zajedno s Hrvatskim druptvom za kardijalnu kirurgiju kada su predstavljene i nove smjernice, RS za zatajivanje srca je aktivno radila na Hrvatskom registru bolniËkih bolesnika sa zatajivanjem srca, RS za akutni koronarni sindrom je organizirala skup u Buzinu gdje su svicentri ukljuËeni u prsten primarne PCI, kao i neki centri(Slavonski Brod) koji se uskoro planiraju ukljuËiti u mreæu predstavili svoje rezultate i izmjenili iskustva. Aktivne su bile i RS za prevenciju i rehabilitaciju, kardiovaskularnu farmakologiju, a osobito je istaknut doprinos prim. Ivanupe na ure.ivanju Kardio lista i web portala druptva. U proteklom mandatnom razdoblju su predstavljene nove smjernice za lijeËenje valvularnih bolesti srca, za perioperacijsko zbrinjvaanje kardiolopkih bolesnika, za prevenciju i rehablitaciju, za akutni koronarnisindrom, za lijeËenje endokarditisa i za elektrostimulaciju srca. U radu odbora za smjernice Europskog kardiolopkog druptva (ESC) su sudjelovaliprof. MiliËiÊ, prof. Bergovec, prof. PetraË, prof. Mirat, dr. SkoriÊ i dr. VraæiÊ. HKD je u proteklom mandatnom razdoblju aktivno sura.ivalo s Hrvatskim druptvom za hipertenziju, Hrvatskim druptvom za aterosklerozu, Hrvatskim druptvom za debljinu i Hrvatskim internistiËkim druptvom. Posebno je istaknut novi izgled i sadræaj web portala i Kardio lista, dvojeziËnost i interaktivnost, redovitost u izlaæenju Kardio lista kao i indeksiranost. Nastavljena je i unaprije.ena uspjepna suradnja s poznatim kardiolopkim institucijama iz SAD-a: Cleveland Clinic, Texas Heart Institute koji je bio suorganizator sastanka odræanog ove jeseni u Splitu (Split Vacular Forum 2010), AnnArbor Univesity Michigan Ëiji je uvaæeni Ëlan prof. dr. Stevo Julius bio predavaË na kongresu i koja Êe uskoro ponuditi stipendije za mlade kardiologe te Mayo Clinic. Prof. MiliËiÊ je istaknu izrazitu uspjepnost Dubrovnik ESC Update sastanka koji je odræan u Dubrovniku 2009. god. i koji Êe se nastaviti odræavati svake dvije godine pod nazivom Dubrovnik Cardiology Highlights — an ESC Update Programme in Cardiology. Tako.er je iznesena aktivnost Ëlanova HKD u sklopu ESC: Congress Programme Commite2008-10 (prof. MiliËiÊ, akademik Reiner), CPC 2010-12(prof. MiliËiÊ), Credentials Commite 2008-2010 (prof. MiliËiÊ), Educational Commite 2010 (prof. MiliËiÊ), Task Forcefor Update (prof. MiliËiÊ), Guidelines Commite (akademikReiner). Prim. dr. KrstaËiÊ je postao tajnik RS za primjenuraËunala u kardiologiji ESC-a. Prof. MiliËiÊ je tako.er izvjestio o aktivnostima glede ukljuËivanja Hrvatske u me.unarodni registar za akutni koronarni sindrom koji se vodi uBologni te o ukluËivanju u europske registre. Istaknuta je i aktivnost u sklopu udruæenja Alpe Adria Cardiology(Board, godipnji kongresi). Potom je prof. MiliËiÊ izvjestio o preuzimanju atraktivnih prostora za Hrvatsku kuÊu srca u samom srediptu Zagreba te da je nakon dvije godine administrativnih postupaka registrirana Zaklada pto je bio the Society was convened with the available minutes of the meeting posted on the web portal of the CCS in journal Kardio list, the Working Group (WG) for Arrhythmias organized 2 meetings in Zagreb, WG for Valvular Diseases organized a meeting in the house of Croatian Medical Association together with the Croatian Society for Cardiac Surgery when new guidelines were presented, WG for Heart Failure was actively working on the Croatian Registry of in-hospital patients with heart failure, WG for Acute Coronary Syndrome organized the meeting in Buzin where all centers were included in the Primary PCI network, as some centers (Slavonski Brod) that soon plan to join the network presented their results and exchanged experience. The WGs for Prevention and Rehabilitation, Cardiovascular Pharmacology were active, and the contribution of Head Dr. Ivanupa to editing Kardio list and web portal of the Society was especially emphasized. During the previous term of office, some new guidelines for the treatment of valvular heart diseases, for perioperative management of cardiac patients, prevention and rehabilitation, acute coronary syndrome, treatment of endocarditis and electrostimulation of heart were presented. Prof. MiliËiÊ, Prof. Bergovec, Prof. PetraË, Prof. Mirat, Dr. SkoriÊ and Dr. VraæiÊ participated in the work of the Board for the guidelines of the European Society of Cardiology (ESC). During the previous term of office, the CCS actively cooperated with the Croatian Society of Hypertension, Croatian Society for Atherosclerosis, Croatian Society for the Study of Obesity and Croatian Society for Internal Medicine. The new layout and the contents of the web portal and Kardio list, bilingual and interactive edition, regular publishing of Kardio list and indexation were specially emphasized. The successful cooperation with famous cardiac institutions from the USA has been continued and improved: Cleveland Clinic, Texas Heart Institute that was co-organizer of the meeting held this autumn in Split (Split Vacular Forum 2010), Ann Arbor University Michigan whose renowned member Prof. Dr. Stevo Julius was the lecturer at the Congress and that will soon offer scholarships for young cardiologists at the Mayo Clinic. Prof. MiliËiÊ has mentioned highly successful Dubrovnik ESC Update meeting that was held in 2009 in Dubrovnik and that will continue to be held every 2 years entitled Dubrovnik Cardiology Highlights — an ESC Update Programme in Cardiology. The activity of the CCS members within ESC has also been mentioned: Congress Programme Commite (CPC) 2008-10 (Prof. MiliËiÊ, Academician Reiner), CPC 2010-12(Prof. MiliËiÊ), Credentials Committee 2008-2010 (Prof. MiliËiÊ), Educational Committee 2010 (Prof. MiliËiÊ), Task Forcefor Update (Prof. MiliËiÊ), Guidelines Committee (Academician Reiner). Head Doctor Dr. KrstaËiÊ has become the Secretary of the ESC WG for the Computers in Cardiology. Prof. MiliËiÊ has also informed the attendees about the activities regarding the entry of Croatia in the international register for acute coronary syndrome maintained in Bologna and about entry in the European registers. The activity within the Association Alpe Adria Cardiology (Board, annual congresses) hasbeen emphasized. Afterwards, Prof. MiliËiÊ has informed the attendees about takeover of the attractive premises for the Croatian Heart House in the very center of Zagreb and that after 2 years of administrative procedures the Foundation was established which was the prerequisite for the Croatian Heart House to start functioning. The premises are located in 2010;5(12):307. preduvjet za poËetak funkcioniranja Hrvatske kuÊe srca. Prostor se nalazi u Oktogonu na adresi Ilica 6. HKD je u proteklom mandatnom razdoblju nastavilo s radom na programu specijalizacije iz kardiologije, s radom na unaprije. enju laiËke reanimacije, aktivno je sura.ivalo s HZZO-om na poboljpanju broja ugra.enih ICD i CRT te na registraciji novih lijekova u kardiologiji (klopidogrel, rosuvastatin, ranolazin). Druga toËka dnevnog reda je bila izvjepÊe rizniËara dr. MargetiÊa koji je kratko izvjestio o financijskom poslovanju druptva, koje je ocijenito vrlo povoljnim. Godipnji obraËun uslijedit Êe nakon pto se zatvori financijska konstrukcija Kongresa. TreÊa toËka dnevnog reda je bila izvjepÊe tajnika dr. PoËaniÊa koji je apelirao na sve Ëlanove druptva da do- stave svoje e-mail adrese i da redovito prate web portal druptva na adresi www.kardio.hr kako bi na vrijeme biliupoznati sa svim aktivnostima i struËnim skupovima kojeorganizira HKD. Tako.er je prenio izvjepÊe dotadapnjegpredsjednika EtiËkog odbora o tome da nije bilo etiËkihupita, a time niti potrebe za sastajanjem EtiËkog odbora. »etvrta toËka dnevnog reda je bila izvjepÊe predsjednika Nadzornog odbora prof. Mirata koji je izvjestio da u proteklom mandatnom razdoblju nije bilo povreda statutarnih odredaba drupta, a time niti potrebe za sastajanjem Nadzornog odbora. Peta toËka dnevnog reda je bila izvepÊe prof. Bergovca koji je izvjestio o aktivnom sudjelovanju hrvatskih kardiologa u brojim me.unarodnim znanstvenim studijama (OASIS 5, OASIS 6, ATLAS TIMI...). ©esta toËka dnevnog reda je bila prihvaÊanje svih izvjepÊa koja su prihvaÊena jednoglasno bez prijavljenih za raspravu. Slijedio je izborni dio skupptine. Za novog predsjednika jedini predloæeni kandidat je bio prof. Davor MiliËiÊ, zadopredsjednika prof. Mijo Bergovec, za Ëlanove Upravnog odbora su predloæeni doc. dr. Maja Strozzi, dr. MladenJukiÊ, dr. Hrvoje StipiÊ, prof. dr. Luka ZaputoviÊ, doc. dr. Ivica VukoviÊ, doc. dr. Robert Steiner, doc. dr. Viktor PerpiÊ, prof. dr. Josip Vincelj, doc. dr. Diana DeliÊ BrkljaËiÊ iprim. dr. Albino JoviÊ, za nadzorni odbor su predloæeniprof. dr. Jure Mirat, dr. Pejo SamardæiÊ, prim. dr. VojtjehBrida, prof. dr. Martina LovriÊ BenËiÊ i prim dr. MirjanaJembrek GostoviÊ, i za Ëlanove EtiËkog povjerenstva akademik Vladimir Goldner, akademik Ivo »ikep, prof. dr. ©ime Mihatov, prof. dr. Drago RakiÊ i prim. dr. Mario Ivanupa. Oktogon at address Ilica 6. During its previous term of office CCS continued with its work on specialization program in Cardiology, with its work on improvement of lay reanimation, it actively cooperated with the Croatian Institute for Health Insurance on improvement of a number of implanted AICD and CRT and on registration of new medicines in cardiology (clopidogrel, rosuvastatin, ranolazine). The second item in the agenda was the report by theTreasurer, Dr. MargetiÊ who briefly informed the attendees about the financial position of the Society which he evaluated as very positive. The annual account will be prepared after the financial position relating to the Congress has been evaluated. The third item of the agenda was the report by the Secretary Dr. PoËaniÊ who asked all members of the Society to send their e-mail addresses and to regularly monitor the web portal of the Society at the address www.kardio.hr so that they may be timely familiarized with all activities and expert meetings organized by CCS. He also informed about the report of the former President of the Ethics Board that there were no ethic issues and that convening the meeting of Ethics Board was unnecessary. The fourth item of the agenda was the report by the President of the Supervisory Board, Prof. Mirat who informed the attendees that during the former term of office there were no violations of statutory provisions of the Society, and convening the meeting of the Supervisory Board was unnecessary. The fifth item of the agenda was the report by Prof. Bergovec who informed the attendees about active participation of the Croatian cardiologists in a number of international scientific studies (OASIS 5, OASIS 6, ATLAS TIMI...). The sixth item of the agenda was the acceptance of all reports that were accepted unanimously without reported persons for discussion. The elective part of the Assembly followed. Prof. DavorMiliËiÊ as the only candidate was proposed to be the new President, Prof. Mijo Bergovec was proposed to be the Vice- President, Ass.Prof. Dr. Maja Strozzi, Dr. Mladen JukiÊ, Dr. Hrvoje StipiÊ, Prof. Dr. Luka ZaputoviÊ, Ass.Prof. Dr. IvicaVukoviÊ, Ass.Prof. Dr. Robert Steiner, Ass.Prof. Dr. ViktorPerpiÊ, Prof. Dr. Josip Vincelj, Ass.Prof. Dr. Diana DeliÊ BrkljaËiÊ and Head Doctor Dr. Albino JoviÊ were proposed to be the members of the MB, Prof. Dr. Jure Mirat, Dr. PejoSamardæiÊ, Head Doctor Dr. Vojtjeh Brida, Prof. Dr. MartinaLovriÊ BenËiÊ and Head Doctor Dr. Mirjana Jembrek GostoviÊ were proposed to be the members of the Supervisory Board, while Academician Vladimir Goldner, AcademicianIvo »ikep, Prof. Dr. ©ime Mihatov, Prof. Dr. Drago RakiÊ and Head Doctor Dr. Mario Ivanupa were proposed to the members of the Ethics Committee. 2010;5(12):308. 2010;5(12):308. Slijedilo je tajno glasovanje tijekom kojega je prim. dr. It was followed by secret voting during which Head DocIvanupa iscrpno prikazao rad web portala i Kardio lista. tor Dr. Ivanupa thoroughly presented the work of web portal Nakon prebrojavanja glasova predsjednik izbornog po-and Kardio list. vjerenstva dr. Padovan je iznio rezultate: After counting the votes, the President of the Elective Za predsjednika Hrvatskoga kardiolopkog druptva jeCommittee, Dr. Padovan presented the results: natpoloviËnim brojem glasova izabran prof. dr. Davor Mil- Prof. Dr. Davor MiliËiÊ has been elected the President of iËiÊ the CCS by ordinary majority. Za dopredsjednika Hrvatskoga kardiolopkog druptva jenatpoloviËnim brojem glasova izabran prof. dr. Mijo Ber-Prof. Dr. Mijo Bergovec has been elected the Vice-Presi govec dent of the CCS by ordinary majority. Za Ëlanove Upravnog odbora su izabrani sljedeÊi kandidati / The following candidates have been elected as members of the Management Board: 1. Hrvoje StipiÊ (115 glasova / votes) 2. Mladen JukiÊ (112 glasova / votes) 3. Maja Strozzi (110 glasova / votes) 4. Diana DeliÊ BrkljaËiÊ (108 glasova / votes) 5. Robert Steiner (108 glasova / votes) 6. Luka ZaputoviÊ (98 glasova / votes) 7. Viktor PerpiÊ (90 glasova / votes) 8. Josip Vincelj (89 glasova / votes) Za Ëlanove Nadzornog odbora su izabrani sljedeÊi kandidati / The following candidates have been elected as members of the Supervisory Board: 1. Jure Mirat 2. Pejo SamardæiÊ 3. Martina LovriÊ BenËiÊ 4. Vojtjeh Brida 5. Mirjana Jembrek GostoviÊ Za Ëlanove EtiËkog povjerenstva su izabrani sljedeÊi kandidati / The following candidates have been elected as members of the Ethics Committee: 1. ©ime Mihatov 2. Vladimir Goldner 3. Ivo »ikep 4. Drago RakiÊ 5. Mario Ivanupa Nakon predstavljanja rezultata isti su jednoglasno prih-After the results were presented, they were unanimousvaÊeni, potom je novoizabrani predsjednik druptva prof.ly adopted and then the newly President of the CCS Prof. MiliËiÊ za tajnika druptva ponovno predloæio dr. DarkaMiliËiÊ again proposed Dr. Darko PoËaniÊ to be Secretary, PoËaniÊa, a za rizniËara dr. Eduarda MargetiÊa, oba prijed-and proposed Dr. Eduard MargetiÊ to be Treasurer, theloga su jednoglasno prihvaÊena Ëime je skupptina zavrpila both proposals were unanimously adopted and this is how s radom. the Assembly finished with its work. ZapisniËar / Keeper of the Minutes: Dr. Jopko Bulum Ovjerovitelji zapisnika / Certifiers of the Minutes: Prim. dr. sc. Vjekoslava Raos Prim. dr. sc. Mario Ivanupa Sretna nova godina 2011. . Happy New Year 2011 Uredniptvo Kardio lista 2010;5(12):309. Ostalo Other 2010;5(12):309. Ostalo Other “Radim za srce” “I Work with Heart” Zagreb, 26. rujna 2010. Zagreb, 26th September 2010 Ivana Portolan PajiÊ* Gradski ured za zdravstvo i branitelje, Zagreb, Hrvatska City Office for Health and War Veterans, Zagreb, Croatia O O biljeæavanje Svjetskog dan srca 2010. odræava seveÊ deset godina zadnje nedjelje u mjesecu rujnu, a na preporuku Svjetske kardiolopke federacije i Svjetske zdravstvene organizacije. Hrvatsko kardiolopko druptvo (HKD) u suradnji s Grad- skim uredom za zdravstvo i branitelje Grada Zagreba, Hrvatskom udrugom kardiolopkih medicinskih sestara, Zavodom za javno zdravstvo “Dr. Andrija ©tampar” te Hrvatskim zavodom za javno zdravstvo organiziralo je obiljeæavanje Svjetskog dana srca 2010. pod nazivom “Radim za srce”. Obiljeæavanje je zapoËelo je u srijedu 22. rujna 2010. tiskovnom konferencijom u zgradi Gradske uprave GradaZagreba na kojoj je GradonaËelnik, gospodin Milan BandiÊ pozdravio suradnju Zagreba i HKD te naglasio kako jeosnivanjem Zaklade Hrvatska kuÊa srca Grad Zagreb trajno definiran kao predvodnik u promicanju i oËuvanju kardiovaskularnog zdravlja. Prof. dr. sc. Davor MiliËiÊ, dekan Medicinskog fakulteta SveuËilipta u Zagrebu i predsjednikHKD pozvao je gra.ane da se u pto veÊem broju odazovu na javnozdravstvenu akciju, a poslodavce da prepoznavanjem vaænosti zdravlja zaposlenika uËine vaæan korak u promicanju i unaprje.enju zdravlja srca na radnom mjestu. U Ëetvrtak, 23. rujna 2010. u Velikoj dvorani Zavodaza javno zdravstvo “Dr. Andrija ©tampar” s poËetkom u13,00 sati prof. dr. sc. Davor MiliËiÊ odræao je predavanje o stanju kardiovaskularnog zdravlja u Hrvatskoj. Prof. MiliËiÊ je upozorio na potrebu pokretanja Nacionalnog plana prevencije kardiovaskularnih bolesti (KVB) te na potrebu izrade Akcijskih planova za æupanije, a sve s ciljem smanjenja broja oboljelih i umrlih od KVB. Sredipnji doga.aj obiljeæavanja Svjetskog dana srca, javnozdravstvena akcija “Radim za srce” odræan je na Trgubana Josipa JelaËiÊ u nedjelju, 26. rujna 2010. od 10 do 13sati. Obiljeæavanje je zapoËelo atraktivnim nastupom ZagrebaËkih maæoretkinja, nakon Ëega se prisutnima obratioprof. dr. sc. Davor MiliËiÊ. UnatoË prohladnom i kipnomvremenu na sredipnjem zagrebaËkom trgu sakupio se znatan broj ljudi kojima je izmjeren arterijski tlak (AT), razina glukoze u krvi, odre.en im je indeks tjelesne mase i opseg struka, a podijeljen je velik broj edukativnih materijala. Gra.ani koji su pristupili javnozdravstvenoj akciji dobili su prigodne poklone, a djelatnici Gradskog ureda za zdravstvo prisutnima su dijelili jabuke, vodu i peciva. Fizioterapeuti Poliklinike za prevenciju kardiovaskularnih bolesti i rehabilitaciju demonstrirali su kardio vjeæbe, aËlanovi ZagrebaËkog saveza sportske rekreacije “Sport za sve” prezentirali su tehniku nordijskog hodanja. Gra.ani su mogli vidjeti prezentaciju vjeæbi prilago.enih radnom F F or the last ten years the celebration of the World Heart Day takes place on the last Sunday in September upon recommendation of the World Heart Federation and the World Health Organization. The Croatian Cardiac Society (CCS) in cooperation with the Zagreb City Office for Health and War Veterans, the Croatian Cardiac Nurse Society, Dr. Andrija ©tampar Institute of Public Health and the Croatian National Institute of Public Health organized the celebration of the World Heart Day 2010 named “I Work with Heart”. The celebration started on Wednesday on the 22nd September 2010 by the press conference in the building of the Zagreb City Government when the Mayor, Mr. Milan BandiÊ welcomed the cooperation of the City of Zagreb and the CCS and emphasized that the establishment of the Croatian Heart House Foundation permanently defines Zagreb as a leader in promotion and preservation of cardiovascular health. Professor Dr. Davor MiliËiÊ, Ph.D., the Dean of the Faculty of Medicine of the University of Zagreb and the President of the CCS called upon the citizens to join this public health action in large numbers and employers to recognize the importance of health of the employees and to make an important step in promoting and improving the cardiovascular health at the work place. On Thursday, 23rd September 2010 in the Great Hall of Dr. Andrija ©tampar Institute of Public Health, commencing at 13:00 o’clock, Professor MiliËiÊ held a lecture on the state of cardiovascular health in Croatia. Professor Mili- ËiÊ has warned about the need for initiating a National Plan for the Prevention of Cardiovascular Diseases (CVD) and the need for developing Action Plans for the counties, and all with a goal of reducing the morbidity and mortality from CVD. The central event of the World Heart Day celebration, the public health action “I Work with Heart” was held atthe Ban Josip JelaËiÊ Square on Sunday, 26th of September 2010 from 10 to 13 o’clock. The event started with an attractive performance by the Zagreb Majorettes, after whichProf. MiliËiÊ spoke to participants. In spite of the cold and rainy weather, a significant number of people gathered at the central Zagreb square and they underwent the procedure of measuring blood pressure, blood glucose, body mass index and waist size, and a large number of educational materials were distributed. The citizens who participated in this public health event received appropriate gifts and the employees of the City Public Health Office distributed apples, water and rolls to the participants. The physiotherapists of the Institute for the Cardiovascular Diseases Prevention and Rehabilitation demonstrated cardiac exercises and the members of the Zagreb Federation for Recreation “Sport for All” presented the technique of Nordic 2010;5(12):310. 2010;5(12):310. mjestu, a sve prisutne je posebno razveselio nastup plesne skupine gospo.e Vesne Mimice koja je izvela ples s kipobranima. Policijska uprava zagrebaËka, obiljeæavajuÊi Dan policije, organizirala je veÊ tradicionalnu atletsku utrku “»etirizagrebaËka trga” kojom potiËe na tjelesnu aktivnost i promiËe vaænost tjelesne aktivnosti u oËuvanju zdravlja. Startutrke bio je na Trgu Nikole ©ubiÊa Zrinskog gdje je svimsudionicima utrke izmjeren AT. U utrci je sudjelovalo Ëetiri stotine osoba. U ponedjeljak, 27. rujna 2010. u Policijskoj upravi zagrebaËkoj odræana je zdravstvena akcija za djelatnike up- rave pod nazivom “ Spoznajte svoje brojeve”. Akciji je pristupilo 130 osoba kojima je izmjeren AT, razina glukoze i ukupni kolesterol u krvi te im je odre.en indeks tjelesnemase i opseg struka. Svi su dobili savjet lijeËnika kardiologa o unaprje.enju kardiovaskularnog zdravlja te savjet nutricionista o pravilnom naËinu prehrane. U navedenim aktivnostima sudjelovali su djelatnici Gradskog ureda za zdravstvo i branitelje, Poliklinike za prevenciju i rehabilitaciju kardiovaskularnih bolesti Zagreb, Zavoda za javno zdravstvo Dr. Andrija ©tampar i Hrvatskog zavoda za javno zdravstvo te Ëlanice i Ëlanovi Hrvatskog kardiolopkog druptva, Hrvatske udruge kardiolopkih medicinskih sestara, Udruge za prevenciju prekomjerne teæine, Udruge “Srce”, Udruge studenata CroMSIC, ZagrebaËkog saveza sportske rekreacije te uËenice i uËenici ©kole za medicinske sestre Mlinarska, Zagreb. Svjetska kardiolopka federacija povodom obiljeæavanja Svjetskog dana srca poziva svakog pojedinca da preuzmenadzor i odgovornost nad zdravljem vlastitog srca. RadeÊi za svoje srce pojedinac radi za sebe, svoje zdravlje, svojuobitelj, za svoju buduÊnost! Received: 25th Oct 2010 *Address for correspondence: Gradski ured za zdravstvo i branitelje, Trg Stjepana RadiÊa 1, HR-10000 Zagreb, Croatia E-mail: ivana.portolan-pajic@zagreb.hr Phone: +385-1-610-1245 Fax: +385-1-610-1502 walking. The citizens could observe the presentation of exercises adapted for the workplace, and all the participants were especially cheered up by the performance of the Vesna Mimica dance group which performed a dance with umbrellas. For the Police Day, the Zagreb Police Department organized an already traditional athletic race “Four Zagreb Squares” which promotes physical activity and the importance of physical activity in health preservation. The start of the race was at the Nikola ©ubic Zrinski square where blood pressure of all the participants was measured. There were four hundred participants in the race. On Monday, 27th September 2010, a health action was held in the Zagreb Police Department for the employees named “Know your Numbers”. 130 people participated in the action and they underwent the procedure of measuring blood pressure, blood glucose and total cholesterol, as well as body mass index calculation and waist size measurement. Everybody received a cardiologist’s advice on improvement of cardiovascular health and nutritionist’s advice about a proper healthy diet. The employees of the City Office for Health and War Veterans, Institute for Cardiovascular Diseases Prevention and Rehabilitation, Dr. Andrija ©tampar Institute of Public Health and the Croatian National Institute of Public Health, as well as members of the Croatian Cardiac Society, the Croatian Cardiac Nurse Society, the Association For Overweight Prevention, The “Heart” Association, Medical Student’s Association CroMSIC, Zagreb Federation for Recreation and the students of the Medical School for Nurses, (Mlinarska, Zagreb) took part in the activities. On the World Heart Day the World Heart Federation calls every individual to take control and responsibility for the health of their own heart. Working for his/her heart, the individual works for himself/herself, his/her health, his/her family and his/her future! 2010;5(12):311. Ostalo Other 2010;5(12):311. Ostalo Other Svjetski dan srca 2010. World Heart Day 2010 u Splitu in Split Ingrid TripkoviÊ* Nastavni zavod za javno zdravstvo Splitsko-dalmatinske æupanije, Split, Hrvatska Teaching Institute of Public Health of Split-Dalmatia County, Split, Croatia N N astavni zavod za javno zdravstvo Splitsko-dalmatinske æupanije (NZZJZ SDÆ) u suradnji s kardiolozima KliniËkog bolniËkog centra Split, osmi put je obiljeæio Svjetski dan srca prigodnim aktivnostima. Djelatnici Zavoda organizirali su prigodno mjerenje arterijskog tlaka, tjelesne teæine, visine i opsega struka te odre .ivanje indeksa tjelesne mase svim zainteresiranim gra. anima u Splitu, Imotskom, Sinju, Trogiru, Makarskoj, Omipu, u Jelsi na Hvaru i u Supetru na BraËu dana 26. rujna 2010. godine u vremenu od 10 do 12 h. Gra.ani su ujedno dobili savjete o vaænosti zdravog naËina æivota i Ëimbenicima rizika za bolesti srca i krvnih æila. Aktivnosti su nastavljene tijekom sljedeÊeg tjedna te su svi zainteresirani gra.ani u uspostavama Nastavnog zavoda za javno zdravstvo Splitsko dalmatinske æupanije mogli pristupiti mjerenjima i savjetovanju. Dana 29. rujna 2010. god. u Gradskoj knjiænici Marka MaruliÊa odræano je predavanje “Prevencija srËanoæilnih bolesti”, povodom Svjetskog dana srca i otvaranja Savjetovalipta za prevenciju srËanoæilnih bolesti pri NZZJZSDÆ u Sluæbi za epidemiologiju masovnih kroniËnih bolesti. Dana 6. listopada 2010. zapoËelo je s radom Savjetovalipte za prevenciju srËanoæilnih bolesti gdje gra.ani mogu saznati svoj kardiovaskularni rizik, izmjeriti arterijski tlak, tjelesnu teæinu, visinu, odrediti indeks tjelesne mase i bazalni metabolizam, izmjeriti postotak masnog tkiva i mipiÊne mase, a tako.er i odrediti glukozu, kolesterol i trigliceride u krvi. Savjetovalipte Êe biti otvoreno za gra.ane jednom tjedno — srijedom od 10 do 12 sati, u Sluæbi zaepidemiologiju kroniËnih masovnih bolesti (Vukovarska 35A), preko puta glavne zgrade NZZJZ SDÆ. Received: 26th Oct 2010 *Address for correspondence: Nastavni zavod za javno zdravstvo Splitsko-dalmatinske æupanije, Vukovarska 46A, HR-21000 Split, Croatia E-mail: ingrid_tripkovic@net.hr Phone: +385-21-401-111 T T he Teaching Institute of Public Health of Split-Dalmatia County has in cooperation with the cardiologists of the Clinical Hospital Centre Split, celebrated the World Heart Day for the eighth time with suitable activities. On the 26th of September 2010 from 10 to 12 o’clock the employees of the Institute organized appropriate measurements of blood pressure (BP), body weight, height and waist size as well as body mass index (BMI) calculation for all the interested citizens in Split, Imotski, Sinj, Trogir, Makarska, Omip, Jelsa on Hvar and Supetar on the island ofBraË. The citizens also received advices on the importance of healthy living and the risk factors for cardiovascular diseases. The activities continued during the following week, so all the interested citizens could undergo measurements and counseling at the branches of the Teaching Institute of Public Health of Split-Dalmatia County. The lecture entitled “The Prevention of Cardiovascular Diseases” was held on the 29th of September 2010 in theCity Library of Marko MaruliÊ, celebrating the World Heart Day and the opening of the Counsel for the Prevention of Cardiovascular Diseases at the Teaching Institute of Public Health of Split-Dalmatia County, Chronic Mass Disease Epidemiology Department. On the 6th of October 2010 the Counsel for the Prevention of Cardiovascular Diseases started with work. It enables the citizens to find out their cardiovascular risks, to measure BP, body weight, height, calculate the BMI and the basal metabolism, measure the body fat and muscle mass percentage, as well as glucose, cholesterol and triglyceride blood levels. The Counsel will be opened for public once a week — Wednesdays from 10 to 12, at the Chronic Mass Disease Epidemiology Department (Vukovarska 35A), opposite the main building of the Teaching Institute of Public Health of Split-Dalmatia County. 2010;5(12):312. Ostalo Other 2010;5(12):312. Ostalo Other Svjetski dan srca 2010. World Heart Day 2010 u Osijeku in Osijek Sandra MakaroviÊ* KliniËki bolniËki centar Osijek, Osijek, Hrvatska Clinical Hospital Centre Osijek, Osijek, Croatia O O biljeæavanje Svjetskog dana srca, pod nazivom “Radim za srce”, odræano je kao i dosadapnjih godina, u Osijeku dana 26. rujna 2010. godine na Trgu Ante StrËeviÊa od 10-13 sati u organizaciji Zavoda za javno zdravstvo Osijek, Udruge kardiovaskularnih bolesnika Osijek te Odjela kardiologije KliniËkog bolniËkog centra Osijek. Glavni sponzor bila je farmaceutska tvrtka Krka. Napi su gra.ani toga dana imali priliku mjeriti arterijski tlak, glukozu u krvi, odre.ivati indeks tjelesne mase te postavljati pitanja glede prepoznavanja Ëimbenika rizika za razvoj kardiovaskularnih bolesti. Akciji se odazvalo oko 500 ljudi, koji su mogli uzeti i prigodni promotivni matrijal. Cijeli je doga.aj bio i primjereno medijski popraÊen, tako su izjavu za medije dali prof. dr. sc. Tibor Santo, lijeËnik Zavoda za javno zdravstvo Osijek te lijeËnici Odjela za kardiovaskularne bolesti KBC Osijek, Miroslav ©ram i Krepimir JeliÊ koji su naglasili vaænost pravovremenog prepoznavanja veÊ dobro utvr.enih Ëimbenika rizika u nastanku neæeljenih kardiovaskularnih doga.aja. Pritom su istaknulipto sam pacijent moæe uËiniti za svoje srce, u promjenama lopih æivotnih navika u smislu reduciranja prekomjerne tjelesne teæine, provo.enja dnevne tjelesne aktivnosti, prestanka pupenja, smanjenja stresa na poslu, promjene vrsteprehrane s naglaskom na namirnice sa pto manje zasiÊenihæivotinjskih masti, pto uËestalije konzumiranje ribe bogateomega-3 masnim kiselinama te voÊa i povrÊa. Istaknuto jei da su koronarna bolest i moædani udar vodeÊi uzrok smrti u veÊini zemalja, pa tako i kod nas. Zbog toga je bitnoæivjeti zdravo, Ëime se moæe prevenirati znaËajan brojsrËanih i moædanih udara. Received: 25th Oct 2010 *Address for correspondence: KliniËki bolniËki centar Osijek, J. Hutlera 4, HR-31000 Osijek, Croatia E-mail: sandramakarovic@yahoo.com Phone: +385-31-511-511 T T he celebration of the World Heart Day, named “I Work with Heart”, was held as during the previous years in Osijek on the 26th of September 2010 at theAnte StarËeviÊ Square from 10:00 to 13:00 o’clock, in the organization of the Public Health Institute of Osijek, Osijek Association of Cardiovascular Patients and the Cardiology Department of the Clinical Hospital Center Osijek. The main sponsor was the pharmaceutical company Krka. On that day our citizens had an opportunity to measure blood pressure, blood glucose, to determine their body mass index and to ask questions about the recognition of risk factors for the development of the cardiovascular diseases. Some 500 people appeared and they were presented and given appropriate promotional material. The entire event was appropriately covered in the media, and statements for the media were issued by Professor Dr. Tibor Santo, Ph.D., the physician from the Public Health Institute of Osijek, as well as physicians from the Department for Cardiovascular Diseases of the Clinical Hospital CenterOsijek, Miroslav ©ram and Krepimir JeliÊ who emphasized the importance of timely detection of well defined risk factors for the development of the adverse cardiovascular events. In doing so, they emphasized what a patient can do for his own heart, by changing bad habits reducing excessive body weight, daily physical activity, giving up smoking, reducing work-related stress, changing his diet with emphasis on the food with less saturated animal fat, more frequent consumption of fish rich in omega-3 fatty acids, fruit and vegetables. It was emphasized that the coronary disease and stroke are the leading cause of death in most countries, including Croatia. Therefore it is important to live healthy, which can prevent a significant number of heart attacks and strokes. 2010;5(12):313. Ostalo Other 2010;5(12):313. Ostalo Other Akcija “Radim za srce”“I Work with Heart” u KorËuli Activities in KorËula Davor Podbevpek* Humanitarna udruga”KorËulansko-peljepko srce”, KorËula, Hrvatska Humanitarian organization “KorËula-Peljepac Heart”, KorËula, Croatia P P ovodom obiljeæavanja Svjetskog dana srca u KorËuli je 2. listopada 2010. godine na prostoru Spomenika na Plokati odræana prigodna akcija u okviru javnozdravstvene manifestacije “Radim za srce”. Glavna svrha akcije bila je upozoriti stanovniptvo na problem srËano-æilnih bolesti te njihov utjecaj na pobol i smrtnost puËanstva. Akciju su prvi puta zajedno organizirale i provele Humanitarna udruga “KorËulansko-peljepko srce” i Gradsko druptvo Crvenog kriæa KorËula. Nakon kra- Êeg zabavno-edukativnog programa u kojem su sudjelovanje male maæoretkinje KorËule, provedena je akcija kontrole zdravstvenog stanja puËanstva — mjerenje arterijskog tlaka, glukoze u krvi i tjelesna mjerenja, uz zdravstvene savjete lijeËnika Doma zdravlja KorËula. Na zadovoljstvo organizatora, akciji kontrole zdravstvenog stanja se odazvao veliki broj sugra.ana. UoËeno je da je kod veÊine ljudi prisutan problem prekomjerna tjelesne teæine i tjelesne neaktivnosti. Po opÊem mipljenju sudionika, akcija je bila odliËno organizirana i provedena. Organizatori zahvaljuju svima koji su pomogli u organizaciji ove manifestacije, kao i svim sugra.anima koji su se odazvali. U planu je odræavanje iste manifestacije 16. listopada u OrebiÊu o Ëemu Êemo javnost na vrijeme detaljnije informirati. Received: 25th Oct 2010 *Address for correspondence: KorËulansko Peljepko Srce, Cvijetno naselje broj 33/B, HR-20260 KorËula, Croatia E-mail: davor.podbevsek@du.htnet.hr T T he World Heart Day was celebrated in KorËula on the 2nd October 2010 in the area of the monument on Plokat with appropriate activities within the public health event “I Work with Heart”. The main purpose of the activity was to alarm population about the problem of cardiovascular diseases and their influence on the morbidity and mortality of the population. For the first time the activities were jointly organized and managed by the humanitarian organization “KorËula- Peljepac Heart” and the Red Cross Society of the City of KorËula. After a short entertainment and educational program which included young majorettes from KorËula, the action of testing the health of the population was conducted and it included — blood pressure, blood glucose and body measurements, with medical advices from physicians of the Medical centre KorËula. To satisfaction of the organizer, a large number of citizens responded to the health testing action. It was observed that most people have problems with obesity and physical inactivity. In the general opinion of the participants, the activity was very well organized and conducted. The organizers wish to thank everybody who helped in the organization of this event, as well as to all the citizens who came to participate in this event. The same event is planned in OrebiÊ on the 16th of October and we shall timely inform the public in more details about that. 2010;5(12):314. Ostalo Other 2010;5(12):314. Ostalo Other Novosti s 21. Novelties from the 21st internacionalnog kongresaInternational Congress on o trombozi Thrombosis Ana BroniÊ*, Jasna LeniËek-Krleæa KliniËka bolnica Sestre milosrdnice, Zagreb, Hrvatska Clinical Hospital “Sestre milosrdnice”, Zagreb, Croatia U U razdoblju od 6. do 9. srpnja 2010. god. u organizaciji Mediteranske lige za prevenciju tromboembolijskih bolesti (MLTD) odræan je 21. internacionalni kongres o trombozi (ICT) u Milanu. MLTD imadugu tradiciju i definiranu ulogu u okupljanju baziËnihznanstvenika i kliniËara koji se bave trombozom kao zasebnim entitetom1. Prema mipljenju prof Mannucci, predsjednika 21. ICT, kraj prve dekade 21. stoljeÊa bio je pravi trenutak da se sumiraju najvaæniji koraci napravljeni naovom podruËju. U najveÊem dijelu predavanja opisani su potencijal iprimjena novih molekula u lijeËenju tromboembolijskihbolesti. Nove spoznaje o pojedinim Ëimbenicima u sustavu hemostaze rezultirale su razvojem novih protuzgrupavajuÊih lijekova. Presudan korak napravljen je poËetkom primjene direktnih inhibitora trombina (DTI), oralnih pripravaka koji se daju u fiksnim dozama, a koji se ne vezuju za proteine plazme pto rezultira predvidljivijim protuzgrupavajuÊim odgovorom. Inhibiraju trombin vezan na fibrin iliaktivaciju Ëimbenika zgrupavanja ukljuËenih u nakupljanjetrombina, pto znaËi da rutinski koagulacijski testovi nisupraktiËni za njihov slijed. Stoga je izveden zakljuËak da jeneophodno razviti nove dijagnostiËke testove i unaprijediti istraæivanja na ovom polju. Odabir prikladne farmakoterapije, usmjerene na inhibiciju agregacije trombocita iËimbenike koagulacijske kaskade u svrhu sprjeËavanja nastanka ugrupka ili njegovog propirenja u krvnim æilama zahtjeva veliku paænju, a rizik od krvarenja mora biti svedenna minimum. VeÊina istraæivanja je pokazala da je primjena novih strategija lijeËenja efikasnija uz sliËne ili nepto slabije nuspojave. Korist i rizik primjene acetilsalicilne kiseline (ASK) u primarnoj i sekundarnoj prevenciji akutnog koronarnog sindroma (ACS) i dalje su predmet brojnih istraæivanja i debata. Godine 2009. meta-analiza randomiziranih studija je utvrdila da je efikasnost primjene ASK nepto manja nego pto se to do sada mislilo. Me.utim, nedavna istraæivanja su pokazala da istovremena primjena ASK s novijim antitrombocitnim lijekovima poput tienopiridina (klopidogrela, tiklopidina i prasugrela), P2Y12 antagonista (ticagrelor i cangrelor), inhibitora glikoproteina IIb-IIIa (abciximab, eptifibatide, tirofiban) uzimajuÊi u obzir individualne faktore rizika, vrijeme terapije i dozu, minimalizira rizik i optimizira ishod bolesti. Primjena klopidogrela uz ASK u ACS, pokazala je poboljpanje ishoda kod pacijenata i u sluËaju potrebe za trombolizom ili primarnom perkutanom koronarnom intervencijom. Kao efikasan derivat tienopiridinapokazao se i prasugrel, Ëija primjena poboljpava kliniËki ishod i stanje pacijenata s infarktom miokarda s elevacijom ST-segmenta. D D uring the period from 6th to 9th July 2010, the 21st International Congress on Thrombosis (ICT) was held organized by the Mediterranean League Against Thromboembolic Diseases (MLTD) in Milan. The MLTD has a long tradition and a defined role in gathering basic scientists and clinicians who deal with thombosis as a special entity1. In opinion of Prof. Mannucci, the President of the 21st ICT, the end of the first decade of then 21st century was the right moment to sum up the most important steps taken in this area. In the largest number of lectures, the potential and application of new molecules in treatment of thromboembolic diseases were described. The new information about specific factors in the system of haemostasis has resulted in the development of new anticoagulation drugs. The crucial step was taken at the beginning of the application of direct thrombin inhibitor (DTI), oral medicines administered in fixed doses that are not bound to plasma proteins, resulting in foreseeable anticoagulation response. They inhibit the thrombin bound to fibrin or activation of the factors of coagulation included in gathering thrombins which means that the routine coagulation tests are not practical for their sequence. Therefore, the conclusion is that it is necessary to develop some new diagnostic tests and improve researches in this field. The selection of appropriate pharmacotherapy focused on the inhibition of the aggregation of trombocytes and factors of coagulation cascade for the purpose of prevention of occurrence of clot or its spreading in blood vessels requires our due attention, while the risk of bleeding must be reduced to minimum. Most of the researches showed that the application of new strategies is more efficient with similar or somewhat less significant side-effects. The benefit and risk of application of aspirin in the primary and secondary prevention of acute coronary syndrome (ACS) are still the subject of a number of researches and debates. In 2009 the meta-analysis of randomized studies determined that the efficiency of application of aspirin is somewhat less than what it was believed to be. However, the recent researches showed that the simultaneous application of aspirin with new antiplatelet drugs such as thyenopiridine (clopidogrel, ticlopidine and prasugrel), P2Y12 antagonists (ticagrelor and cangrelor), glycoprotein IIb-IIIa inhibitors (abciximab, eptifibatide, tirofiban) considering individual risk factors, time of therapy and dose, minimizes the risk and optimizes the outcome of the disease. The application of clopidogrel along with aspirin in ACS has showed the improvement of the outcome in a patient and in the case of a need for thrombolysis or primary percutaneous coronary intervention. Prasugrel proved to be an efficient thyenopiridine derivate, the application of which 2010;5(12):315. Za sve pacijente s fibrilacijom atrija te visokim rizikom kardioembolijskog moædanog udara, neovisno o dobitrenutne smjernice preporuËuju produæenu terapiju s varfarinom ili u sluËaju kontraindikacije ASK. Prema novijim podacima primjena umjerenih doza DTI dabigatrana u sekundarnoj prevenciji moædanog udara (MU) se pokazala efikasna poput varfarina, uz nepto manje nuspojava. Obzirom da se dabigatran primjenjuje u fiksnim dozama te jesmanjena potreba za njegovim monitoringom obeÊava u prevenciji ponovnih embolijskih doga.aja kod pacijenata s kardioembolijskim MU. Tkivni aktivator plazminogena (rt-PA) dokazan je trombolitik, me.utim istraæivanja djela individualnih komponenti fibrinolitiËkog sustava poput plazminogena, inhibitora plazmina i TAFI-a dala su opreËne rezultate. Razlog nekonzistentnosti je najvjerovatnije posljedica njihovih nefibrinolitiËkih karakteristika npr. uloge u upali i angiogenezi. Novije pretkliniËke studije su pokazale da neke metaloproteinaze (MMPs) primjenjene s malim dozama rt-PA mogu biti efikasan trombolitik, a bez izazivanja sistemskoglitiËkog stanja kod arterijske tromboze. Kako bi se definirale skupine pacijenata koje bi od navedenog najvipe profitirale neophodna su dodatna istraæivanja. Kao relativno nova i potentna tehnologija u lijeËenju predstavljena je i tvz. antisense tehnologija inhibicije proteina. Terapija se bazira na hibridizaciji mRNA putem visokospecifiËnih oligonukleotida. Posljedica je selektivnoosloba.anje ciljane mRNA pto vodi odgovarajuÊoj redukciji i selektivnoj inhibiciji ciljanog proteina. Studije na æivotinjama podræale su ovaj koncept, me.utim neophodna su dodatna istraæivanja i njezina daljnja evaluacija. Istraæivanja o novim antikoagulansima pokazala suznaËajne rezultate, me.utim, Ëitav niz pitanja ostao je otvoren. Antidoti, monitoring, utjecaj na laboratorijske testove te eventualne nuspojave tek se trebaju istraæiti, a konaËni zakljuËci biti Êe poznati nakon pto se objave rezultati 3. i 4. faze kliniËkih studija. Vipe novosti, kao i detalja onavedenim istraæivanjima, moæe se pronaÊi u specijalnomizdanju Ëasopisa Pathophysiology of thrombosis and haemostasis objavljenom na stranicama MLTD-a2. Nove spoznaje i smjernice zasigurno Êe biti prikazanena 22. ICT koji Êe se odræati tijekom listopada 2012. god. u Nici u Francuskoj3. IstraæivaËi i kliniËari iz Hrvatske pozvani su da aktiviraju svoj rad u MLTD jop tijekom 20. ICT koji je odræan krajem lipnja 2008 god. u Ateni. U radu 21. ICT kongresa sa posterskim radovima sudjelovalo je nekoliko kolega. Hrvatska mediteranskom podneblju pripada zemljopisno iklimatski, a kao i u veÊini tranzicijskih europskih zemalja tromboembolijske bolesti su joj veliki javnozdravstveni problem. Udio osoba umrlih zbog bolesti srca i krvnih æila u Hrvatskoj u ukupnom mortalitetu 2007. godine iznosioje 50,6%, a vodeÊe dijagnostiËke podskupine bile su ishemijske bolesti srca s udjelom od 36,5% te cerebrovaskularne bolesti s udjelom 31,4%. Epidemiolopki podaci o udjelu VTE u pobolu i smrtnosti za Hrvatsku tek trebaju biti utvr.eni4-6. Jedan od osnovnih ciljeva MLTD-a u buduÊnosti je stvaranje mreæe radnih skupina i postavljanje internacionalnih projekata sa svrhom istraæivanja epidemiologije, dijagnoze i lijeËenja tromboze. Kako bi se to moglo ostvariti, neophodno je da se u rad Lige ukljuËi pto veÊi brojstruËnjaka iz svih zemalja Ëlanica, pa tako i iz Hrvatske. improves the clinical outcome and condition of a patient with myocardial infarction with ST-segment elevation. For all patients with atrial fibrillation and a high risk of cardioembolic stroke, regardless of age, the current guidelines suggest extended therapy with varfarin or aspirin in the case of contraindication. According to the most recent data, the application of moderate DTI doses of dabigatran in the secondary prevention of stroke has proved to be more efficient such as varfarin with a fewer number of side- effects. Since dabigatran is applied in fixed doses and the need for its monitoring has been reduced, it is promising in the prevention of recurring embolic events in patients with cardioembolic stroke. The tissue plasminogen activator (rt-PA) is a proved thrombolytic drug, the researches of the part of individual components of fibrinolytic system such as plasminogen, plasmin inhibitor and TAFI have provided opposite results. The reason for inconsistency may be a consequence of their non-fibrinolytic characteristics, such as the role in inflammation and angiogenesis. The latest preclinical studies have showed that some metalloproteinases (MMPs) applied in small doses rt-PA may be an efficient thrombolytic agent without causing systemic lytic state in the arterial thrombosis. In order to define the groups of patients that would mostly benefit from the above mentioned, some additional researches need to be conducted. The so-called antisense technology of protein inhibition is a relatively new and potent technology. The therapy is based on hybridization of mRNA through highly specific oligonucleotides. The consequence is a selective release of the target mRNA which leads to reduction and selective inhibition of the target protein. The studies on animals have supported this concept, but some additional researches and its new evaluation are required. The researches on new anticoagulation agents have showed some significant results, but there are a great number of open issues. Antidotes, monitoring, the impact on the laboratory tests and any potential side-effects need to be researched and the final conclusions will be known after the results of the 3rd and 4th stage of clinical studies have been published. More news and details about the above researches may be found in special issue of the journal Pathophysiology of thrombosis and haemostasis publicized on the website of MLTD2. Some new information and guidelines will be certainly presented at the 22nd ICT that will be held during October 2012 in Nice in France3. The researches and clinicians from Croatia were invited to activate their work in MLTD at the 20th ICT that was held by the end of June 2008 in Athens. There are several colleagues who participated in their poster presentations in the work at the 21st ICT. Croatia has Mediterranean climate with regard to geographical and climatic features and as in the most of transitional European countries thromboembolic diseases are a great public and health problem. The share of persons who died as a consequence of cardiovascular diseases in Croatia in total mortality in 2007 was 50.6% and the leading diagnostic sub-groups were the ischemic heart diseases with a share of 36.5% and cerebrovascular diseases with a share of 31.4%. The epidemiologic data on the share of VTE in morbidity and mortality are only to be 2010;5(12):316. 2010;5(12):316. Godine 2006. osnovana je i Zaklada MLTD Ëija Êe aktivnosti biti usmjerena na Ëlanove Lige, znanstvenu zajednicu mediteranskih zemalja kao i na pacijente koji su oboljeli ili su pod rizikom oboljenja od arterijske ili venske tromboze kroz njihova udruæenja na podruËju mediteranske zajednice. determined for Croatia4-6. One of the basic goals of MLTD in the future is the creation of the network of work groups and preparation of the international projects with a purpose of researching epidemiology, diagnosis and treatment of thrombosis. As to be able to accomplish that objective, it is necessary to have greater number of experts involved in the work of the League from all member states and Croa tia as well. In 2006 the MLTD Foundation was established Received: 12th Nov 2010 whose activity will be focused on the League members, Klinika za traumatologiju, KliniËka bolnica Sestre milosrdnice, scientific community of the Mediterranean countries and DrapkoviÊeva 19, HR-10000 Zagreb, Croatia patients who suffer or are at risk to suffer from arterial or E-Mail: anabronic@yahoo.com venous thrombosis through their associations in the regionPhone: +385-1-46-97-186 of the Mediterranean community. Fax: +385-1-46-10-365 Literature 1. www.medleague-thrombosis.org 2. www.medleague-thrombosis.org/mltd/league_library_official_ journal.php 3. www.thrombosis2012.org 4. Kern J, Strnad M, Coric M, Vuletic S. Cardio vascular risk factors in Croatia: struggling to provide the evidence for developing policy recommendations. BMJ. 2005;331:208-10. 5. Kralj V, Hrabak-ÆerjaviÊ V. Javnozdravstveni znaËaj kardiovaskularnih bolesti. Kardio list. 2008;3(9-10):73-6. 6. BroniÊ A. Thromboembolic diseases as biological and clinical syndrome - Role of the Mediterranean League against Thromboembolic Diseases. Biochem Med. 2010;20(1):9-12. Ostalo Other Radionica “UltrazvuËna Workshop “Ultrasounddijagnostika u prevenciji iDiagnostics in Prevention rehabilitaciji and Rehabilitation of kardiovaskularnih bolesti” Cardiovascular Diseases” Goran KrstaËiÊ*, Mirjana Jembrek-GostoviÊ Poliklinika za prevenciju kardiovaskularnih bolesti i rehabilitaciju, Zagreb, Hrvatska Institute for Cardiovascular Diseases Prevention and Rehabilitation, Zagreb, Croatia U U Polikllinici za prevenciju kardiovaskularnih bolesti i rehabilitaciju u Zagrebu je 5. studenoga 2010. godine odræana Radionica “UltrazvuËna dijagnostika u prevenciji i rehabilitaciji kardiovaskularnih bolesti”. Ciljradionice je bio prezentacija tehnolopkih moguÊnosti modernih ultrazvuËnih ure.aja i njihova primjena u dijagnostici srËanih pobola. Nakon uvodnih rijeËi mr. sc. prim. Mirjane Jembrek- GostoviÊ, ravnateljice Poliklinike i Tomislava Krsnik, direktora tvrtke Medicom, odræana su dva predavanja. Najprijeje prof. dr. sc. Jadranka ©eparoviÊ-HanæevaËki iz Klinike zabolesti srca i krvnih æila KliniËkog bolniËkog centra Zagreb, odræala predavanje “Ehokardiografija i hemodinamika — sve pto se æeljeli znati, a niste mogli pitati” u kojemje izloæila prikaz najznaËajnijih i najËepÊih bolesti srca ikrvnih æila uz praktiËni slikovni ehokardiografski i hemodinamski prikaz. Posebito su naglapene hemodinamskekarakteristike, moguÊe zamke i dvojbe kod dijastoliËke disfunkcije srca, kvantitativna analiza funkcije lijeve klijetke, hipertenzivno srce te ehokardiografski parametri srËanihgrepaka i optimalan trenutak upuÊivanja na kardiokirupko zbrinjavanje. Potom je dr Katarzina Olszowska-Pawluczuk, regionalni voditelj za kardiovaskularne ure.aje Ge O O n 5th November 2010 the workshop “Ultrasound Diagnostics in Prevention and Rehabilitation of Cardiovascular Diseases” was held in the Institute for Cardiovascular Diseases Prevention and Rehabilitation. The objective of the Workshop was the presentation of technological achievements of ultrasound devices and their use in the diagnostics of cardiac diseases. Two lectures were held following the introductorywords by Head Doctor Mirjana Jembrek-GostoviÊ, M.Sc., the Principal of the Institute and Tomislav Krsnik, Directorof the company Medicom. First, Prof. Jadranka ©eparoviÊ- HanæevaËki, PhD from the Clinic for Cardiovascular Diseases of the Zagreb Clinical Hospital Center gave a lecture “Echocardiography and Hemodynamics — all you have always wanted to know, but could not ask about” where she gave an overview of the most important and frequent cardiovascular diseases thereby using echocardiographic and hemodynamic images. Hemodynamic characteristics, potential traps and doubts in case of diastolic heart dysfunction, quantitative analysis of the left ventricular function, hypertensive heart and echocardiographic parameters of cardiac failures as well as the best moment for sending a patient for cardiosurgical procedure were specially empha 2010;5(12):317. neral Electrics Medical Systems, odræala predavanje “Tehnolopke moguÊnosti modernih ultrazvuËnih ure.aja” u kojem je na vrlo zanimljiv naËin prezentirala razvoj ultrazvuËnih ure.aja tvrtke GE u kardiologiji, od ne tako davne proplosti i pionirskih ostvarenja u nizu danas rutinski etabliranih ehokardiografskih pretraga (npr. prvi ure.aj za transezofagijski ehokardiogram), do najsuvremenijih danapnjih ure.aja, primjerice Vivid 7 ili 4-D ure.aj Vivid 9 ili pak atraktivni portabl Vscan. U praktiËnom dijelu radionice uz prof. ©eparoviÊ-HanæevaËki i dr Olszowska-Pawluczuk te dvije medicinske sestre iz ehokardiografskog laboratorija KBC Zagreb, sudjelovali su gotovo svi kardiolozi Poliklinike i vipe medicinskih sestara. Na dva ure.aja GE Vivid 7 i jednom Vivid 5, na kojima inaËe svakodnevno rade djelatnici Poliklinike, demonstrirane su moguÊnosti ovih suvremenih ultrazvuËnih aparata, u funkciju je stavljena radna stanica na koju Êe se pohranjivati svi uËinjeni ehokardiografski nalazi te su prikazane tehniËke moguÊnosti naknadne analize pohranjenih nalaza. Sponzor ove radionice bila je tvrtka Medicom, generalni zastupnik General Electric Medical Systems za Hrvatsku, kao dar Poliklinici povodom obiljeæavanja 60-te obljetnice rada, a vjerujemo da Êe ovakova zbivanja postati tradicionalna. Received: 25th Nov 2010 *Address for correspondence: Poliklinika za prevenciju kardiovaskularnih bolesti i rehabilitaciju, DrapkoviÊeva 13, HR-10000 Zagreb, Croatia; Phone: +385-1-4612-290; E-mail: goran.krstacic@zg.t-com.hr sized. Afterwards, Dr Katarzina Olszowska-Pawluczuk, the regional manager for cardiovascular devices General Electrics Medical Systems, gave a lecture “Technologic Possibilities of Modern Ultrasound Devices” where she presented the development of the ultrasound devices of the company GE in Cardiology in a very interesting way, starting from a series of pioneer achievements of routinely established echocardiographic tests which did not occur long ago (such as, the first device for transesophageal echocardiogram), to the most sophisticated modern devices used nowadays, such as Vivid 7 or 4-D device Vivid 9 or some more attractive portable device Vscan. Besides Prof. ©eparoviÊ-HanæevaËki, Dr Olszowska-Pawluczuk and two nurses from echocardiographic laboratory of the Zagreb Clinical Hospital Center, almost all cardiologists from the Polyclinic and senior nurses participated in the practical part of the workshop. All possibilities of these state-of-theart devices were demonstrated on the two devices GE Vivid 7 and one Vivid 5, on which the employees of the Institute daily work, a work station that will include all performed echocardiographic tests stored was put in function. Technical possibilities of subsequent analysis of the stored tests were also demonstrated. This workshop was sponsored by the company Medicom, the authorized dealer of General Electric Medical Systems for Croatia as the gift to the Institute on occasion of celebrating the 60th anniversary of its work and we believe that such events will become traditional and usual events. 2010;5(12):318. Ostalo Other 2010;5(12):318. Ostalo Other Five-Year Work of the Pet godina rada Laboratorija Laboratory for the za kateterizaciju srca i Catheterization of Heart invazivnu kardiologiju and Invasive Cardiology ofKliniËkog bolniËkog centra the Clinical Hospital CentreOsijek in Osijek Sandra MakaroviÊ* KliniËki bolniËki centar Osijek, Osijek, Hrvatska Clinical Hospital Centre Osijek, Osijek, Croatia U U subotu 6. studenoga 2010. godine na Medicinskom fakultetu u Osijeku odræan je, povodom proslave pet godina rada Laboratorija za kateterizaciju srca i invazivnu kardiologiju, simpozij “Dosezi i tendencije u invazvnoj kardiologiji”. Tom sveËanom prigodom uvodnu rijeË i predavanjeodræao je Predstojnik KliniËkog odjela za bolesti srca i krvnih æila doc. dr. sc. Robert Steiner na temu “Invazivna kardiologija u KliniËkom bolniËkom centru Osijek”. Istaknuo je da je od otvaranja laboratorija 17. lipnja 2005. god. i prve koronarografije u Osijeku pa do 2010. uËinjeno ukupno 3.465 koronarografija, postavljeno 1.495 stentovate 279 hitnih i 983 elektivnih PCI, Ëime je opravdana potreba za invazivnom kardiologijom ne samo u Osijeku i æupaniji, nego i cijeloj Slavoniji i Baranji. »ast i obveza jeukljuËivanje Laboratorija u Hrvatsku mreæu za zbrinjavanje oboljelih od akutnog infarkta miokarda, pto je potvrda dobrog rada i organizacije urgentnog zbrinjavanja kardiolopkih bolesnika. Od poËetka rada do danas u napem kateterizacijskomlaboratoriju radi petero lijeËnika, doc. dr. sc. Robert Steiner, dr. Damir Kozmar, dr. Vedrana Baraban, dr. Zorin MakaroviÊ, dr. Damir Kirner, inæenjeri Ivica Weinberger i Domagoj Boban te medicinske sestre Marija PopiÊ, MarijaMediÊ, Vedran Na., Marija MatiÊ, Dubravka LonËar i Dubravka Ramljak. Istaknuto je da laboratorij za kateterizaciju srca, uspjepno pokriva piroko podruËje koje obuhvaÊapet æupanija (OsjeËko-baranjska, Vukovarsko-srijemska, VirovitiËko-podravska, Brodsko-posavska i Poæepko-slavonska), a zbrinut je i po koji bolesnik i iz drugih æupanija. »ast nam je bila pozvati i poslupati invazivne kardiologe doc. dr. sc. Maju Strozzi koja je u svom izvrsnom predavanju prikazala dosege i tendencije u invazivnoj kardiologiji i prof. dr. sc. Robert Bernat koronarografiju transradijalnim pristupom. Potom su dr. Vedrana Baraban i dr. Zorin MakaroviÊ prikazali najzanimljivije sluËajeve iz osobnog iskustva rada u ovih pet godina. Zajedno smo imalipriliku Ëuti uvijek zanimljive i korisne teme iz podruËja invazivne kardiologije te razmotriti naËine poboljpanja radai odræavanja struËnosti. Ujedno su podijeljene zahvalnice od kolegama koji su prepoznali potrebu za otvaranjem kateterizacijskog labora O O n Saturday, on 6th November 2010 the symposium “Results and Tendencies in Invasive Cardiology” was held at the Faculty of Medicine in Osijek on occasion of celebration of the five-year work of the Laboratory for the Catheterization of Heart and Invasive Cardiology. On that ceremonial occasion, the word of introduction and the lecture was given by the Principal of the Clinical Department for the cardiovascular diseases Ass. Prof. Robert Steiner, PhD on the topic “Invasive Cardiology in the Clinical Hospital Centre Osijek”. He mentioned that since opening of the laboratory on 17th June 2005 and the first Coronarography Department in Osijek till 2010 a total number of 3.465 coronarographies have been performed, 1.495 stents and 279 emergency and 983 elective PCIs have been implanted which justifies the need for invasive cardiology not only in Osijek and the County, but in whole Slavonija and Baranja. We are honored and obligated to include the Laboratory in the Croatian Network for the management of persons suffering from acute myocardial infarction which is a confirmation for the good work and organization of urgent management of cardiac patients. From the start of the work to date, five physicians have been working in our catheterization laboratory, these are Ass. Prof. Robert Steiner, PhD, Dr. Damir Kozmar, Dr. Vedrana Baraban, Dr. Zorin MakaroviÊ, Dr. Damir Kirner, engineers Ivica Weinberger and Domagoj Boban and nursesMarija PopiÊ, Marija MediÊ, Vedran Na., Marija MatiÊ, Dubravka LonËar and Dubravka Ramljak. It has been pointed out that the laboratory for heart catheterization successfully covers a wide area that includes five counties (the County of Osijek and Baranja, the County of Vukovar and Srijem, the County of Virovitica and Podravina, the County of Brod and Posavina and the County of Poæega and Slavonija) while some patients from other counties have been managed too. We were honored to invite and listen to invasive cardiologists Ass. Prof. Maja Strozzi, PhD who showed us the results and tendencies in invasive cardiology in her excellent lecture and Prof. Rober Bernat, PhD who spoke about transradial approach in coronarography. Following that, Dr. Vedrana Baraban and Dr. Zorin MakaroviÊ showed some of the most interesting cases from their personal work experience during these five years. We all had an opportunity to listen to always interesting and useful topics in the area of invasive cardiology and consider the methods of improvement of our work and maintenance of expertise. torija te nam pomogli u njegovom nastajanju i radu. TimeAt the same time, Certificates of Gratitude were hanse neizmjerno puno uËinilo za pacijente iz podruËje cijele ded out to colleagues who recognized the need for ope 2010;5(12):319. Slavonije i Baranje, te okolnih gravitirajuÊih æupanija Ëime smo omoguÊili pacijentima zbrinjavanje ravno zapadno europskim centrima. Zahvalnice su sveËano dodijeljene doc. dr. sc. Maji Strozzi, koja je od poËetka prihvatila i educirala nape prve invazivne kardiologe u KBC Zagreb kao i sve ostale osjeËke invazivce te im zajedno s ostalim kolegama nesebiËno prenosila svoje znanje, prof. dr. sc. Draganu KovaËeviÊu predsjedniku upravnog vijeÊa KBC Osijek, doc. dr. sc. Æeljku Vranjepu ravnatelju KBC Osijek, prof. dr. sc. Aleksandru VËevu predstojniku Interne klinike KBC Osijek, prof. emeritusu Antunu Tucaku, prof. dr. sc. Krepimiru Glavini, mr. sc. Marijanu JakiÊu tadapnjem ravnatelju osjeËke bolnice, koji se prisjetio lijeËenja srËanih infarkta iz vremena prije otvaranja laboratorija za kateterizaciju srca. Zahvalnice su dodijeljene i dr. Ranku Ugljenu predstojniku Odjela kardiokirurgije KBC Osijek, koji je prihvativpi rad u KBC Osijek omoguÊio otvaranje kardijalne kirurgije te prof. dr. sc. Katji »atipoviÊ Veselici, tadapnjoj predstojnici kardiolopkog odjela koja je ustrajala uz udrugu Kardiovaskularnih bolesnika u ideji i realizaciji otvaranja kateterizacijskog laboratorija. SveËenosti su prisustvovali i brojni gosti te kardiolozi iz Zagreba, Splita, Rijeke, Krapinskih Toplica te Slavonskog Broda. Nakon zavrpenog sluæbenog sveËanog dijela predavanja, druæenje smo nastavili u Baranji parku prirode KopaËkom ritu i atraktivnom restoranu Kormoran, gdje je uz dijetalni menu i tamburape atmosfera bila vesela, a razgovor smo nastavili u neformalnijem obliku. Simpozij je bio bodovan od strane lijeËniËke komore, a odræan uz pomoÊ sponzora farmaceutskih tvrtki Sonimeda, te Belupa i GE. Received: 14th Nov 2010 *Address for correspondence: KliniËki bolniËki centar Osijek, J. Hutlera 4, HR-31000 Osijek, Croatia E-mail: sandramakarovic@yahoo.com Phone: +385-31-511-511 ning of the Catheterization laboratory and helped us in its creation and work. In this way, we have done a lot for the patients from the area of whole Slavonija and Baranja and surrounding gravitating counties, whereas we provided our patients with the management equaling the management in the west European centers. The Certificates of Gratitude were solemnly awarded to Ass.Prof. Maja Strozzi, PhD who from the beginning accepted and educated our first invasive cardiologist in the Zagreb Clinical Hospital Centre and all other Osijek invasive cardiologists and unselfishly transferred her knowledge to her colleagues, Prof. Dragan KovaËeviÊ Phd, President of the Management Council of the Osijek Clinical Hospital Centre, Ass.Prof. Æeljko Vranjep PhD, the Principal of the Osijek Clinical Hospital Centre, Prof. AleksandarVËev, PhD the Principal of the Internal Medicine Clinic of the Osijek Clinical Hospital Centre, Prof. Emeritus AntunTucak, Prof. Krepimir Glavina PhD, M.Sc. Marijan JakiÊ former Principal of the Osijek Hospital, who remembered the treatment of myocardial infarction from the period prior to opening of the Laboratory for Heart Catheterization. The Certificates of Gratitude were also awarded to Dr. Ranko Ugljen, the Principal of the Cardiosurgery Department of the Osijek Clinical Hospital Centre who after having accepted the job in the Osijek Clinical Hospital Centre enabled opening the Cardiac Surgery and Prof. Katja »atipoviÊ Veselica PhD, the former Principal of the Cardiology Department who insisted on the idea and realization of opening of the Catheterization Laboratory together with the Association of the cardiovascular patients. The ceremonies were attended by a number of guests and cardiologists from Zagreb, Split, Rijeka, Krapinske Toplice and Slavonski Brod. After the official ceremonial part of the lecture finished, we continued to socialize in Baranja, the Nature Park KopaËki rit and attractive restaurant Kormoran in cheerful atmosphere with diet menu and tambura players and we conducted talks in a more informal way. The Symposium was credited by the Croatian Medical Chamber and it was held with the aid of sponsors, the pharmaceutical company Sonimed, Belupo and GE. 2010;5(12):320. Ostalo Other 2010;5(12):320. Ostalo Other Iz povijesti kardiologije u From the History Zagrebu of Cardiology in Zagreb Mirjana Jembrek-GostoviÊ* Poliklinika za prevenciju kardiovaskularnih bolesti i rehabilitaciju, Zagreb, Hrvatska Institute for Cardiovascular Diseases Prevention and Rehabilitation, Zagreb, Croatia P P oliklinika za prevenciju kardiovaskularnih bolesti i rehabilitaciju proslavila je 24. studenoga 2010. godine60. obljetnicu rada. SveËanost je odræana u Preporodnoj dvorani HAZU, pod pokroviteljstvom gradonaËelnika. Proslavi je prisustvovao veliki broj uglednika medicinske struke, sadapnjih i bivpih djelatnika te prijatelja i vanjskih suradnika ustanove. Detaljnije o obiljeæavanju godipnjiceproËitajte na http://www.srcana.hr/hr/vijesti/pregled/11/, Nap pokupaj oæivljavanja povijesnog i radnog materijala testvaralaËkog potencijala napih djelatnika objavljen je u prigodnoj monografiji i filmu. Za Ëitatelje Kardio lista ovom prilikom citiramo dio materijala u kojem je daleke 1950. godine, prigodom prijedloga za osnivanje tadapnjeg Dispanzera za bolesti srca(sadapnje SrËane) dr Miljenko Kraus prepoznao znaËaj kardiovaskularnih bolesti u pobolu i smrtnosti ukupnog, a posebno radno sposobnog stanovniptva. Dr. Miljenko Kraus, u ime Povjereniptva za narodno zdravlje Narodnog odbora Grada Zagreba, u Izvjeptaju i prijedlogu za osnivanje Dispanzera iz 1950. godine navodi: “...Do sada nije postojala ustanova, koja bi u cjeliniobuhvatila i vodila brigu o srËanim bolesnicima i to ne samo za vrijeme njihove nesposobnosti, nego koja bi se bavila i prouËavanjem zaptitnih mjera za oËuvanje zdravlja takvih bolesnika. U napoj dræavi, prema statistici, umire godipnje od bolesti srca oko 60.000 ljudi, a od istih bolesti boluje 300.000 do 400.00 ljudi. Ako pretpostavimo, da od ovih 400.000 njih 300.000 pripada trudbenicima tj. radnim ljudima, odnosno osiguranicima, i ako svaki od njih izostane sa rada godipnje 30 dana, a pto nije visoka brojkazbog samoga karaktera oboljenja, to znaËi, da napa privreda gubi 9.000.000 radnih dana na godinu... Svakako, da Êe jedna ustanova, kao pto je Dispanzer za bolesti srca, mnogo utjecati na sniæavanje postotka oboljenja od srca i na gubitak radnih dana. Toj ustanovi jedan od glavnih zadataka biti Êe briga o srËanim bolesnicima, nadalje ocjenjivanje stepena radne sposobnosti, poduzimanje potrebnih mjera, kako srËani bolesnik ne bi uopÊe dolazio u stanje nesposobnosti za rad...” Received: 8th Dec 2010 *Address for correspondence: Poliklinika za prevenciju kardiovaskularnih bolesti i rehabilitaciju, DrapkoviÊeva 13, HR-10000 Zagreb, Croatia; Phone: +385-1-4612-290; E-mail: ravnateljica@srcana.hr T T he Institute for Prevention of Cardiovascular Diseases celebrated on 24th November 2010 its 60th anniversary. The ceremony was held in the Illyrian Hall of Croatian Academy of Sciences and Arts under Mayor’s auspices. The celebration was attended by a great number of renowned persons in the field of medicine, present and former employees, friends and outsourced associates of the Institution. Find more details about the celebration of the anniversary at http://www.srcana.hr/hr/vijesti/pregled/11/ (Croatian language only). Our attempt to revive the historic and working material and creative potential of our employees has been publicized in the relevant monograph and film. For the Kardio list readers we shall quote a part of the material when in 1950 upon proposal for the establishment of the former Clinic for Cardiac Diseases (today’s SrËana) Dr. Miljenko Kraus recognized the importance of cardiovascular diseases in morbidity and mortality of total, especially working population. Dr. Miljenko Kraus, acting on behalf of the Committee for National Health of the National Board of the City of Zagreb mentions the below sentence in the Report and proposal for establishment of the Clinic from 1950: “...So far, there has been no institution that would completely include and take care of cardiac patients, not only during their inability, but that would engage in studying protective measures for the preservation of health of such patients. In our country, according to statistical surveys, some 60,000 thousand people die of cardiac diseases and some 300,000 to 400,000 people have some cardiac diseases. Assuming that out of 400,000 people, some 300,000 persons are working people paying social and health insurance and if each of them is absent from work for 30 days a year, which is not a high number considering the nature of the disease itself, this means, our economy will lose 9,000,000 working days a year... The institution such as Clinic for Cardiac Diseases will definitively contribute to reduction of percentage of heart diseases and days of absence from work. One of the main tasks for this Institution will be the care about cardiac patients, evaluation of the degree of work ability, undertaking required measures as to generally prevent the work inability of cardiac patients...” 2010;5(12):321. STRANICA SPONZORA • SPONSOR’S PAGE Kratko priopÊenje Short communication 2010;5(12):321. STRANICA SPONZORA • SPONSOR’S PAGE Kratko priopÊenje Short communication ©to jop moæemo uËiniti What more can we do u lijeËenju pacijenata s when treating patients hiperlipidemijom? with hyperlipidemia? Janez Poles1, Jernej Kos2, Breda BarbiË-Æagar2, Mateja Gropelj2 1Bolninica Topolpica, Topolpica, Slovenija / Bolnipnica Topolpica, Topolpica, Slovenia 2Krka, d. d., Novo Mesto, Slovenija / Krka, d. d., Novo Mesto, Slovenia SAÆETAK: KliniËka praksa pokazuje da svega polovica pacijenata u sekundarnoj prevenciji dosegne ciljnu vrijednost LDL kolesterola pto ukazuje na problem neadekvatne kontrole LDL. U jednoj od najnovijih studija s Krkinim atorvastatinom (Atoris®), procijenjeno je dostizanje ciljnih razina lipida i to je uspore.eno s rezultatima prethodnih godina. Rezultati su pokazali da lijeËenje atorvastatinom statistiËki znaËajno i sigurno sniæava razine ukupnog kolesterola, LDL i triglicerida kod razliËitih skupina pacijenata, ukljuËujuÊi i osobe starije æivotne dobi. Usporedba sa studijom provedenom 2007. je pokazala da je tada prosjeËno svega 50% pacijenata postiglo ciljne razine LDL uz prosjeËnu dozu atorvastatina od 19,5 mg. U najnovijoj studiji iz 2009. godine, ciljne razine LDL postiglo je 71% pacijenata uz prosjeËnu dozu od 26,9 mg atorvastatina dnevno. KLJU»NE RIJE»I: atorvastatin, hiperlipidemija, stariji pacijenti. H H iperlipidemija predstavlja jedan od glavnih Ëimbenika rizika za kardiovaskularne bolesti (KVB) — glavnog uzroËnika smrti u razvijenim zemljama1. Europske smjernice sugeriraju da je glavni cilj lijeËenja hiperlipidemije razina LDL kolesterola koja bi se, uz promjenu naËina æivota, trebala primarno reducirati terapijom statinima. ©tovipe, europske smjernice daju toËne ciljne vrijednosti koje bi se trebale postiÊi u lijeËenju pacijenata s hiperlipidemijom2. Cilj lijeËenja i naËini njegovog ostvarenja su jasno definirani. No, pto pokazuje kliniËka praksa? Prema rezultatima studije EUROASPIRE III, koja je ukljuËivala 22 europske zemlje, samo otprilike polovica pacijenata u sekundarnoj prevenciji koronarne bolesti srca (KBS) dosegne svoj ciljni LDL pto ukazuje na problem neadekvatne kontrole LDL u svakodnevnoj bolniËkoj praksi3. Ovo je jedna od vaænih Ëinjenica koju istiËu i Krkine studije4-6. U jednoj od najnovijih studija s Krkinim atorvastatinom, evaluirano je i uspore.eno postizanje ciljnih razinalipida s rezultatima prethodnih godina. Studija je ukljuËivala piroki raspon pacijenata te su obavljene dodatne podanalize na zasebnim skupinama pacijenata, ukljuËujuÊi starije od 65 godina, one s KBS, zatajivanjem srca, cerebrovaskularnim bolestima, dijabetesom te pacijenata s perifernom arterijskom bolesti4. Studija se sastojala od 3 posjete: prva pri ukljuËivanju u studiju, druga nakon jednogmjeseca lijeËenja (nije bila obvezna), a treÊa posjeta 4 do6 mjeseci nakon ukljuËivanja u studiju. Od 1.162 pacijenata, u statistiËku analizu je ukljuËeno njih 1.124 (51% mupkaraca, 49% æena) — 56% je uklju- Ëeno u primarnoj prevenciji, a 38% u sekundarnoj preven- ABSTRACT: Clinical practice shows that only about half of the patients in secondary prevention reach their target LDL cholesterol levels, which points to the problem of inadequate LDL control. In one of the latest studies with Krka’s atorvastatin (Atoris®), achieving target lipid levels was evaluated and compared with the results of the previous years. Evaluation of results showed that treatment with atorvastatin statistically significantly and safely reduced total cholesterol, LDL cholesterol and triglyceride levels in different groups of patients, including the elderly. Comparison with the study conducted in 2007 showed that at that time there were on average only 50% of patients who achieved LDL target levels and the average dose of atorvastatin was 19.5 mg, while in the latest study conducted in 2009, there were 71% of patients who achieved the LDL cholesterol target levels and the average dose was 26.9 mg of atorvastatin per day. KEYWORDS: atorvastatin, hyperlipidemia, elderly patients. CITATION: Kardio list. 2010;5(12):321-323. H H yperlipidemia is one of the major risk factors for cardiovascular disease (CVD) — a major cause of death in developed countries1. European guidelines suggest that the main treatment target of hyperlipidemia is the LDL cholesterol level which should be, in addition to lifestyle changes, reduced primarily by statin treatment. What is more, the European guidelines give us exact target values which should be achieved when treating patients with hyperlipidemia2. The goal of treatment and the means to achieve it are clearly defined. But what does the clinical practice show? According to the EUROASPIRE III study, which included 22 European countries, only about half of the patients in secondary prevention of coronary heart disease (CHD) reach their LDL target levels, which points to the problem of inadequate LDL in every-day clinical practice3. This is one of the important highlights of Krka’s own clinical studies as well. In one of the latest studies with Krka’s atorvastatin, achieving target lipid levels was evaluated and compared with the results of the previous years. The study included a wide range of patients and additional subanalyses were performed on separate groups, including patients of more than 65 years of age, patients with CHD, heart failure, cerebrovascular disease, diabetes, and patients with peripheral artery disease4. The study consisted of 3 visits: the first visit at inclusion, the second after one month of treatment (not obligatory), and the third visit 4 to 6 months after the inclusion. Out of 1.162 patients, 1.124 were considered in the statistical analysis (51% male, 49% female) ? 56% were in 2010;5(12):322.STRANICA SPONZORA • SPONSOR’S PAGE 2010;5(12):322.STRANICA SPONZORA • SPONSOR’S PAGE ciji (nije bilo podataka za 6% pacijenata). U 29% pacijenata registriran je dijabetes, infarkt miokarda kod njih 13%, perkutana koronarna intervencija kod 7%, angina pektoris kod 7%, periferna arterijska bolest kod 7% i moædani udar kod 13%. Gotovo polovica pacijenata bila je starija od 65 godina (prosjeËna dob 62,7 ± 10,5). Vipe od 70% pacijenata nije bilo prethodno lijeËeno hipolipemicima. Pacijenti su primali atorvastatin (Atoris®) u dozama od 10 do 80 mg. U prosjeku su bili lijeËeni gotovo 5 mjeseci (147 dana). Na kraju studije, vipe od jedne treÊine pacijenata bilo je lijeËeno s 40 ili vipe mg atorvastatina. ProsjeËna dnevna doza atorvastatina na zavrpetku studije iznosila je 26,9 mg4. Glavni rezultati su predstavljeni u tablici 1, a znaËajke odre.enih skupina pacijenata i rezultati podanaliza predstavljeni su u tablicama 2 i 3. LijeËenje atorvastatinom u svim dozama (tako.er od 40 mg i vipe) je statistiËki znaËajno smanjilo ukupni kolesterol, razine LDL i triglicerida kod razliËitih skupina pacijenata, ukljuËujuÊi i osobe starije æivotne dobi i bilo je sigurno4,5. cluded in primary prevention and 38% in secondary prevention (there were no data for 6% of patients). Diabetes was reported in 29% of patients, myocardial infarction in 13%, percutaneous coronary intervention (PCI) in 7%, angina pectoris in 7%, peripheral artery disease in 7%, and stroke in 13%. Almost one half of the patients were at least 65 years of age (the average age of patients was 62.7 ± 10.5 years). Over 70% of the patients had not been treated with hypolipidemic drugs before. The patients were receiving atorvastatin (Atoris®) in doses from 10 mg to 80 mg. On average they were treated for almost 5 months (147 days). At the end of the study, more than one third of the patients were treated with 40 mg of atorvastatin or more. The average daily dose of atorvastatin at the end of the study was 26.9 mg4. The main results are presented in Table 1, and the characteristics of certain groups of included patients and the results of subanalyses of their data are presented in Tables 2 and 3. Treatment with atorvastatin statistically significantly and safely reduced total cholesterol, LDL and triglyceride levels in different groups of patients, including the elderly, in all doses, also 40 mg and more4,5. Table 1. Lipid levels measured at each visit of the study. The percentages in the brackets represent the relative reduction compared to the lipid level measured at the first visit. The reduction of total cholesterol, LDL cholesterol and triglycerides was statistically significant in all three groups (p<0.0001). HDL cholesterol increase was in all three groups statistically nonsignificant (2.3% at the second visit and 3.3% at the third visit compared to the first visit)4. Table 2. The relative lipid changes at the last visit (after 6 months of treatment) in different groups of patients (the results of the subanalyses). Kao pto je veÊ istaknuto, udio pacijenata koji su postigli ciljne razine LDL kolesterola je jedna od vaænih Ëinjenica koju istiËe i Krkina vlastita kliniËka studija sa statinima. Ona omoguÊava usporedbu uËinkovitosti lijeËenja kod razliËitih skupina pacijenata, kao i procjenu poboljpanja u lijeËenju tijekom godina. Stoga smo usporedili rezultate studije provedene 2009. god. s rezultatima jedne od kliniËkih studija koja je s Krkinim atorvastatinom provedena dvije As already pointed out, the percentage of patients achieving LDL cholesterol target levels is one of the important highlights of Krka’s own clinical studies with statins. It allows us to compare the efficacy of the treatment among different groups of patients, as well as evaluate the improvements in the treatment through the years. Therefore, we compared the results of this study conducted in 2009 with the results of one of the clinical studies which was 2010;5(12):323. STRANICA SPONZORA • SPONSOR’S PAGE Table 3. Average dose of atorvastatin, average duration of treatment, percentage of patients reaching LDL cholesterol target levels after 4 to 6 months of treatment and the number of patients with adverse events (the results of subanalyses). godine ranije. Usporedba rezultata je pokazala oËigledno poboljpanje. 2007. god. je u prosjeku bilo svega 50% pacijenata koji su postigli ciljne razine LDL, a prosjeËna doza atorvastatina iznosila 19,5 mg dnevno. 2009. god. je 71% pacijenata postiglo ciljne razine uz prosjeËnu dozu od 26,9 mg atorvastatina dnevno (procjena ukupnih rezultata svih skupina pacijenata ukljuËenih u svaku studiju)4,6. Rezultati studije su tako.er potvrdili da je lijeËenje atorvastatinom sigurno. Devedeset i osam posto pacijenata nije imalo nikakve nuspojave. VeÊina nuspojava je bila blaga ili umjerena. NajËepÊe nuspojave su bile bolovi u mipiÊima i svrbeæ4. Moæemo zakljuËiti da je posljednja studija potvrdila uËinkovitost i sigurnost lijeËenja atorvastatinom kod pirokog spektra pacijenata, ukljuËujuÊi starije, u svim dozama, ukljuËujuÊi 40 mg ili vipe. Usporedba ovih rezultata s rezultatima studije Krkinog atorvastatina iz prethodnih godina je pokazala trend boljem praÊenju razina LDL te time prema boljem smanjenju kardiovaskularnog rizika. Kao pto pokazuju rezultati, jop uvijek postoji prostor za daljnja poboljpanja. Received: 4th Dec 2010; Updated 7th Dec 2010 *Address for correspondence: Krka d.d., Dunajska 65, SLO-1000 Ljubljana, Slovenija; Phone: +386-1-4571-339; E-mail: breda.zagar@krka.biz Literature conducted with Krka’s atorvastatin two years earlier. The comparison of the results showed an obvious improvement. In 2007 there were on average only 50% of patients who achieved LDL cholesterol target levels and the average dose was 19.5 mg of atorvastatin per day, while in 2009, there were 71% of patients who achieved the LDL cholesterol target levels and the average dose was 26.9 mg of atorvastatin per day (evaluation of the total results in all groups of patients included in each study)4,6. The results of the study also confirmed that treatment with atorvastatin was safe. Ninety-eight percent of the patients did not experience any adverse events. Most of the adverse events were mild or moderate. The most common adverse events were muscle aches and itching4. We can conclude that with the latest study, the efficacy and safety of atorvastatin treatment were confirmed in a wide range of patients, including the elderly, and for all doses, including 40 mg and more. Comparison of these results with the results of studies with Krka’s atorvastatin from the previous years shows a trend towards keeping a better track of patients’ LDL cholesterol levels, and hence towards better cardiovascular risk reduction. There is still room for further improvement, as shown by the results. 1. Smith SC Jr, Jackson R, Pearson TA, Fuster V, Yusuf S, Faergeman O, et al. Principles for national and regional guidelines on cardiovascular disease prevention. Circulation 2004;109:3112-21. 2. European guidelines on cardiovascular disease prevention in clinical practice. Fourth Joint European Societies’ Task Force on cardiovascular disease prevention in clinical practice. Eur J Cardiovasc Prev Rehabil 2007;14 (suppl 2):E1-E40. 3. Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Keil U; EUROASPIRE Study Group. EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. Eur J Cardiovasc Prev Rehabil 2009; 16(2): 121-37. 4. Ne-intervencijsko spremljanje varnosti in uËinkovitosti atorvastatina (Atoris®) v zdravljenju starejpih bolnikov s hiperlipidemijo, Final clinical report, January 2010; Data on file, Krka, d. d., Novo mesto. Slovenia, 2010. 5. Ne-intervencijsko spremljanje varnosti in uËinkovitosti atorvastatina (Atoris®) v zdravljenju starejpih bolnikov s hiperlipidemijo, PoroËilo o statistiËni analizi — podanalize: bolniki s koronarno boleznijo, bolniki s srËnim popupËanjem, bolniki z moæganskoæilnimi boleznimi, bolniki z diabetesom, bolniki s PAB, February 2010, Data on file, Krka, d. d., Novo mesto. Slovenia, 2010. 6. Poles J. Atoris® pri doseganju ciljnih vrednosti holesterola pri bolnikih s hiperlipidemijo in poveËanim absolutnim tveganjem za srËno-æilne bolezni (ATOP), July 2007, Data on file, Krka, d. d., Novo mesto. Slovenia, 2007. 2010;5(12):324.STRANICA SPONZORA • SPONSOR’S PAGE 2010;5(12):324.STRANICA SPONZORA • SPONSOR’S PAGE