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Showing papers by "Renata Cifkova published in 2014"


Journal ArticleDOI
TL;DR: This paper aims to demonstrate the importance of knowing the carrier and removal status of canine coronavirus, as a source of infection for other animals, not necessarily belonging to the same breeds.
Abstract: ABPMambulatory blood pressure monitoringACEangiotensin converting enzymeARBangiotensin receptor blockerA-Vatrio-ventricularBBbeta-blockerBPblood pressureCHDcoronary heart diseaseCKDchronic kidney d...

599 citations


Journal ArticleDOI
Goodarz Danaei1, Yuan Lu1, Gitanjali M Singh1, Emily Carnahan2  +337 moreInstitutions (9)
TL;DR: In this paper, the authors used data for exposure to risk factors by country, age group, and sex from pooled analyses of population-based health surveys and obtained relative risks for the eff ects of risk factors on cause-specifi c mortality from meta-analyses of large prospective studies.

550 citations


Journal ArticleDOI
TL;DR: In patients with overt vascular disease, circulating dp-ucMGP and d p-cMGP were independently associated with the risk of all-cause and cardiovascular mortality.

70 citations


Journal ArticleDOI
TL;DR: A randomized trial comparing antihypertensive treatment strategies aiming at three different SBP targets in hypertensive patients with a recent stroke or transient ischaemic attack to find the optimal level of low-density lipoprotein cholesterol level.
Abstract: The SBP values to be achieved by antihypertensive therapy in order to maximize reduction of cardiovascular outcomes are unknown; neither is it clear whether in patients with a previous cardiovascular event, the optimal values are lower than in the low-to-moderate risk hypertensive patients, or a more cautious blood pressure (BP) reduction should be obtained. Because of the uncertainty whether 'the lower the better' or the 'J-curve' hypothesis is correct, the European Society of Hypertension and the Chinese Hypertension League have promoted a randomized trial comparing antihypertensive treatment strategies aiming at three different SBP targets in hypertensive patients with a recent stroke or transient ischaemic attack. As the optimal level of low-density lipoprotein cholesterol (LDL-C) level is also unknown in these patients, LDL-C-lowering has been included in the design. (Less)

70 citations


Journal ArticleDOI
TL;DR: More than half of the very substantial fall in CHD mortality in the Czech Republic between 1985 and 2007 was attributable to reduction in major cardiovascular risk factors, and improvement in treatments accounted for approximately 43% of the total mortality decrease.
Abstract: BackgroundCoronary heart disease (CHD) mortality has declined substantially in the Czech Republic over the last two decades.DesignThe purpose of this study was to determine what proportion of this CHD mortality decline could be associated with temporal trends in major CHD risk factors and what proportion with advances in medical and surgical treatments.MethodsThe validated IMPACT mortality model was used to combine and analyse data on uptake and effectiveness of CHD management and risk factor trends in the Czech Republic in adults aged 25–74 years between 1985 and 2007. The main sources were official statistics, national quality of care registries, published trials and meta-analyses, and the Czech MONICA and Czech post-MONICA studies.ResultsBetween 1985 and 2007, age-adjusted CHD mortality rates in the Czech Republic decreased by 66.2% in men and 65.4% in women in the age group 25–74 years, representing 12,080 fewer CHD deaths in 2007. Changes in CHD risk factors explained approximately 52% of the total m...

58 citations


Journal ArticleDOI
TL;DR: Of central adiposity measures, WHtR has the strongest association with aortic stiffness beyond body mass index and cardiovascular risk factors, and may be the best anthropometric measure of excess adiposity in the general population.

49 citations


Journal ArticleDOI
TL;DR: A new, large randomized controlled trial is needed to determine the optimal level of BP and LDL-C for the prevention of recurrent stroke and cognitive decline.
Abstract: It is well established by a large number of randomized controlled trials that lowering blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) by drugs are powerful means to reduce stroke incidence, but the optimal BP and LDL-C levels to be achieved are largely uncertain. Concerning BP targets, two hypotheses are being confronted: first, the lower the BP, the better the treatment outcome, and second, the hypothesis that too low BP values are accompanied by a lower benefit and even higher risk. It is also unknown whether BP lowering and LDL-C lowering have additive beneficial effects for the primary and secondary prevention of stroke, and whether these treatments can prevent cognitive decline after stroke.

43 citations


Journal ArticleDOI
TL;DR: The results suggest that aortic stiffening, by reducing the buffering function of the aorta and thereby increasing the transmission of pressure and flow pulsatility into the cerebral arterioles, may contribute to the pathogenesis of lacunar stroke.
Abstract: OBJECTIVE: Aortic stiffness is increased in lacunar stroke. The precise mechanism linking aortic stiffness to symptomatic lacunar stroke is not well understood. The aim of this study was to compare the effects of aortic stiffness, carotid stiffness, central blood pressure, and cerebrovascular resistance on carotid flow pulsatility according to stroke subtype. METHODS: Two hundred and one consecutive patients were examined 13 months after hospitalization for their first-ever ischemic stroke. The stroke subtype was classified using the Causative Classification of Stroke System. Carotid-femoral pulse wave velocity (PWV) was used as a measure of aortic stiffness. Common carotid flow pulsatility was expressed as resistive index. Central blood pressure was measured using applanation tonometry. RESULTS: Complete data were available for 174 patients (mean age… 67 ± 10 years, 64% men). In patients with lacunar stroke, aortic PWV was higher (13.11 ± 2.74 m/s) than in individuals with large artery atherosclerosis (9.98 ± 1.87 m/s, P <0.001), cardioembolic (11.31 ± 3.18 m/s, P = 0.04) or cryptogenic stroke (11.13 ± 3.2 m/s, P = 0.01). Similarly, central SBP and resistive index were higher in patients with lacunar stroke (145 ± 23 mmHg and 0.80 ± 0.04, respectively) than those with large artery atherosclerosis (128 ± 18 mmHg, P <0.01 and 0.74 ± 0.07, P <0.01, respectively) or cryptogenic stroke (132 ± 18 mmHg, P <0.01 and 0.76 ± 0.07, P <0.05, respectively). In multivariate analysis, aortic stiffness and central pulse pressure were the main determinants of resistive index independent of stroke subtype. CONCLUSION: Our results suggest that aortic stiffening, by reducing the buffering function of the aorta and thereby increasing the transmission of pressure and flow pulsatility into the cerebral arterioles, may contribute to the pathogenesis of lacunar stroke.

28 citations


Journal ArticleDOI
TL;DR: In the cross-sectional analysis from a random sample of the general population, antihypertensive treatment was associated with a less steep increase in the PWV with age and the mean arterial pressure, and further longitudinal studies are needed to confirm this finding.
Abstract: Aortic stiffness is strongly related to age and mean arterial pressure (MAP). In the present analysis, we investigated whether antihypertensive treatment modulates the association of the aortic pulse wave velocity (PWV) with age and with MAP in the general population. In the Czech post-MONICA cross-sectional study, we measured the PWV in 735 subjects (mean age 61.2±7.8 years, 54.1% women, 44.3% on antihypertensive medication). We used a linear regression model to assess the effect of treatment on the PWV. The independent covariates in our analysis included sex, age, MAP, heart rate, body mass index, plasma glucose, low-density lipoprotein cholesterol, smoking and observer. The patients receiving treatment were older (64.1±6.7 vs. 58.9±7.8 years), had higher systolic blood pressure (135.9±16.2 vs. 130.1±16.5 mm Hg) and had higher pulse wave velocity (9.1±2.2 vs. 8.2±2.1 m s−1; P for all <0.0001) than untreated subjects. After adjustment for MAP, the use of treatment modified the association between age and the PWV (regression equations, treated patients 9.68–0.009 × age vs. untreated subjects 6.98+0.020 × age, difference of regression slopes, F=11.2; P=0.0009). In analyses adjusted for age, treatment was associated with a smaller increase of the PWV with MAP (treated patients 9.63–0.006 × MAP vs. untreated subjects 7.18+0.010 × MAP, F=10.70; P=0.0001). These results were driven primarily by subjects whose blood pressure was below 140/90 mm Hg. In the cross-sectional analysis from a random sample of the general population, antihypertensive treatment was associated with a less steep increase in the PWV with age and the mean arterial pressure. Further longitudinal studies are needed to confirm this finding.

17 citations


Journal ArticleDOI
TL;DR: Estimation of cSBP based on the late systolic shoulder of the radial wave provides a comparable accuracy with the validated general transfer function, and when comparing Omron HEM-9000AI and SphygmoCor estimates of c SBP, Omron pSBP2 should be used.

13 citations



Journal ArticleDOI
TL;DR: In this paper, the authors used simple markers and inexpensive screening tools for metabolic disorders associated with insulin resistance and metabolic syndrome identifying subjects at a high cardiovascular risk, such as atherogenic dyslipidemia and hypertriglyceridemic waist.
Abstract: Introduction Many patients with coronary heart disease (CHD) who achieve target low density lipoprotein cholesterol (LDL-C) values still experience vascular events because of a residual vascular risk due to other risk factors, particularly non-LDL-C dyslipidemia, because of non-adherence to non-pharmacological and pharmacological management. Method and aims We used simple markers and inexpensive screening tools for metabolic disorders associated with insulin resistance and metabolic syndrome identifying subjects at a high cardiovascular (CV) risk – atherogenic dyslipidemia [triglycerides (TG) ≥2.0 mmol/l and high-density lipoprotein cholesterol (HDL-C) ≤1.0 mmol/l in males and ≤1.2 mmol/l in females], hypertriglyceridemic waist (TG ≥2.0 mmol/l and waist circumference ≥90 cm in males and ≥85 cm in females), atherogenic index of plasma [AIP = log (TG/HDL-C)] and non-HDL-C (non-HDL-C = total cholesterol − HDL-C)]. We focused on the development of these risk factors among patients with established stable CHD over more than the last 16 years. Results We examined 1484 patients, 1152 males (78%) and 332 females (22%) from the Czech parts of EUROASPIRE I–IV (EA I–IV) surveys. In males, TG, HDL-C, and non-HDL-C decreased significantly from EA I to IV (p for trends NS; 0.0001; 0.0001, respectively). In females, there was no change in TG; HDL-C, and non-HDL-C decreased significantly (p for trends NS; 0.03; 0.0001, respectively). Atherogenic dyslipidemia prevalence decreased significantly in both sexes ( p for trends 0.004 and 0.0012, respectively). Hypertriglyceridemic waist prevalence showed no change in either sex. There were no significant changes in AIP risk strata in either sex. About 30–40% of males and 24–30% of females had their AIP in the high-risk strata, which tended to increase in males. The prevalence of type 2 diabetes (T2DM) and waist circumference increased significantly from EAI to IV (from 23% to 48%, and from 98 cm to 105 cm, respectively; both p for trend Conclusion Despite the increase in T2DM prevalence and waist circumference from EA I to IV, hypertriglyceridemic waist prevalence showed no change and atherogenic dyslipidemia prevalence decreased significantly in both sexes, because not all obese patients are insulin-resistant and not all patients with glucose metabolism disorders present all characteristics of metabolic syndrome. Simple markers of the atherogenic phenotype, especially AIP, should be used in CV risk assessment.

Journal ArticleDOI
TL;DR: Měřeni krevniho tlaku (TK) v domacich podminkach (HBPM) býva spojeno jak se zlepsenim kontroly TK, proto bychom jeho provaděni měli hypertonikům doporucovat s lecbou.
Abstract: Cil: Měřeni krevniho tlaku (TK) v domacich podminkach (HBPM) býva spojeno jak se zlepsenim kontroly TK, tak se zlepsenim compliance s lecbou, proto bychom jeho provaděni měli hypertonikům doporucovat.Metodika: V průřezovem setřeni lecených hypertoniků vybraných z nahodneho vzorku obecne populace (Czech post-MONICA) jsme proto zjisťovali dostupnost a použiti HBPM. V praci jsme použili univariantni a multivariantni logistickou regresi.Výsledky: Ze 449 lecených hypertoniků (průměrný věk 63,2 roku, 52,1 % žen), 250 (55,7 %) jedinců uvedlo, že maji dostupný tlakoměr k měřeni HBPM. Faktory spojene s dostupnosti HBPM byly vyssi věk, rodinný stav, univerzitni vzdělani, delsi trvani hypertenze a nekuřactvi. Z 250 osob, jež měly HBPM k dispozici, si pouze 40 % měřilo TK v domacich podminkach pravidelně (minimalně jednou týdně). Pravidelne použivani korelovalo s poctem uživaných antihypertenziv (monoterapie 30 %, dvojkombinace 43 %, kombinace ≥ tři leků 48 %; p pro trend = 0,028). Kontrola krevniho tlaku vsak byla obdobna u jedinců, kteři HBPM pravidelně uživali v porovnani s těmi, kteři HBPM uživali nepravidelně nebo vůbec (54,5 vs. 49,7%; p = 0,52).Zavěr: Měřeni TK v domacich podminkach je dostupne vice než polovině lecených hypertoniků vybraných z obecne populace. Nicmeně pouze polovina z nich si měři TK v domacich podminkach pravidelně.



Journal ArticleDOI
TL;DR: Uvod: Zakladnim cilem kardiovaskularni prevence je snižit morbiditu a mortalitu a zlepsit kvalitu života pacientů změnami životniho stylu, kontrolou rizikových faktorů a kardioprotektivni medikaci.
Abstract: Uvod: Zakladnim cilem kardiovaskularni prevence je snižit morbiditu a mortalitu a zlepsit kvalitu života pacientů změnami životniho stylu, kontrolou rizikových faktorů a kardioprotektivni medikaci.Cil: Stanovit, jak jsou do praxe implementovana evropska doporuceni sekundarni prevence ischemicke choroby srdecni (ICHS) z let 2007 a 2012.Metodika: Konsekutivně a retrospektivně bylo vybrano 650 pacientů, mužů a žen ve věku ≤ 80 let, hospitalizovaných pro některou z nasledujicich diagnoz: elektivni ci emergentni koronarni bypass nebo perkutanni koronarni angioplastiku anebo akutni koronarni syndrom (akutni infarkt myokardu - STEMI ci non-STEMI nebo akutni ischemii myokardu). Byl proveden rozbor chorobopisů a nasledně byli ambulantně vysetřeni respondenti, minimalně sest měsiců, maximalně tři roky po přijeti k hospitalizaci.Výsledky: Celkem bylo vysetřeno 493 respondentů. Z nich 17 % byli aktivni kuřaci, 42 % bylo obeznich, v pasmu nadvahy a obezity bylo 86 % respondentů, centralně obeznich 69 %, nizkou fyzickou aktivitu (klasifikace IPAQ) vykazovalo 71 %. Neadekvatně zvýsený krevni tlak (≥ 130/80 mm Hg, doporuceni z roku 2007) mělo 75 %, zvýsený LDL cholesterol (≥ 2,5 mmol/l) 39 %, manifestni diabetes (deklarovana lecba diabetu a glykemie nalacno > 7,0 mmol/l) vykazovalo 48 % respondentů. V době vysetřeni bylo 92 % pacientů leceno antiagregancii, 85 % beta-blokatorem, 82 % inhibitorem enzymu konvertujiho angiotensin (ACE) nebo antagonistou receptoru AT1 pro angiotensin II, 93 % statinem. Pouze mala cast pacientů dodržovala doporucena nefarmakologicka opatřeni v sekundarni prevenci.Zavěr: U pacientů v sekundarni prevenci ICHS se zvýsila prevalence nadvahy a obezity a prevalence diabetu. Farmakoterapie je v sekundarni prevenci použivana ve vysokem procentu, neni vsak dosahovano doporucených hodnot krevniho tlaku, lipidoveho a glycidoveho metabolismu, hlavně v důsledku nizkých davek leků. Nadale je neuspokojiva implementace zasad zdraveho životniho stylu.

Journal ArticleDOI
TL;DR: Výsledky et al. as discussed by the authors used metodologie studie Czech post-MONICA bylo v roce 2013 ve městě Brno (Ceska republika) provedeno průřezove setřeni kardiovaskularnich rizikových faktorů.
Abstract: Cil: Zjistit uživani tabaku a některe charakteristiky osob uživajicich tabak (osob uživajicich elektronicke cigarety) souvisejici s kardiovaskularnimi onemocněnimi u reprezentativniho vzorku populace města Brno.Metody: Za použiti metodologie studie Czech post-MONICA bylo v roce 2013 ve městě Brno (Ceska republika) provedeno průřezove setřeni kardiovaskularnich rizikových faktorů. Tato předběžna zprava s udaji prvnich 965 nahodně vybraných dobrovolniků (vcetně 512 žen) ve věku 25-64 let se zaměřuje na uživani tabaku, jeho prevalenci v různých podskupinach i na postoje vůci zakonům a nařizenim omezujicim kouřeni.Výsledky: Tato předběžna analýza hodnoti udaje 965 jedinců průměrneho věku 47,3 ± 11,40 roku. Prevalence kouřeni byla 26,7 %; denně kouřilo 23,3 %, přiležitostně (meně než jednou denně) 3,4 %; 19,9 % vzorku byli bývali kuřaci. Celkem 34,0 % populace bylo exponovano tabaku. Uživani elektronických cigaret uvedlo 3,5 % respondentů, castěji slo o muže (5,1 %) než o ženy (2,1 %; p = 0,020). Souběžne uživani elektronických cigaret a kouřeni uvedlo 2,07 % hodnocene populace.Zavěr: Prevalence uživani tabaku brněnskou populaci v produktivnim věku je 26,70 %, což je stale jestě vysoke cislo.

Journal ArticleDOI
TL;DR: The prevalence of tobacco use in Brno productive population is 26.70%, which is still high, in contrary to the expectation, and the attitudes towards smoke-free policies are still high.
Abstract: AIM: To assess tobacco use and some characteristics of tobacco users relevant to cardiovascular risk factors in a representative sample of population of Brno city. As well, we followed the e-cigarettes use. We expected lower tobacco use compared to the population as rather healthy, motivated and cooperating volunteers tend to participate in monitoring surveys. METHODS: A cross-sectional survey of cardiovascular risk factors was conducted respecting the method of Czech PostMONICA Study, in the district of Brno city in 2013. This preliminary report of first 965 randomly selected volunteers (including 512 women), aged 25-64, focuses on tobacco use, its prevalence in different subgroups as well as the attitudes towards smoke-free policies. RESULTS: As this study reports pilot results, the enrollment still occurs. Therefore, our sample represents so far 35.2% of invited volunteers in average age of 47.3 ±11.40 years. The prevalence of smoking was 26.7%, with daily tobacco use 23.3%, less than once daily 3.4 %, and 19.9 % ex-smokers. Based on self- report, 34.0% were exposed to passive smoking. Electronic cigarette use was observed in 3.5 % of responders. The use of electronic cigarette was more common in men (5.1 %), than in women (2.1 % p=0.020). Concomitant use of electronic cigarettes and smoking was observed in 2.07 % of population. CONCLUSION: The prevalence of tobacco use in Brno productive population is 26.70%, which is still high, in contrary to our expectation.

Journal ArticleDOI
TL;DR: In CHD patients, the simplified MetSy definition using ‘hypertriglyceridemic waist’ provides better prediction for glycemic control than ATP definition.
Abstract: Aim: The definition of metabolic syndrome (MetSy) in patients with coronary heart disease (CHD) remains problematic because of concomitant treatment. We speculate, which definition is suitable in terms of long-term glycemic status. Methods: We analyzed 979 patients with stable CHD. Four different MetSy definitions were used: ‘standard Adult Treatment Panel III (ATP)’, ‘modified ATP’ (not using antihypertensive treatment as an alternative criterion), ‘atherogenic dyslipidemia’ or ‘hypertriglyceridemic waist’. Results: The presence of ‘hypertriglyceridemic waist’ was associated with almost twofold higher risk (OR 1.79; 95% CI: 1.19 – 2.68) of hemoglobin A1c ≥48. Predictive power of standard or modified ATP definitions diminished after adjustment. Conclusion: In CHD patients, the simplified MetSy definition using ‘hypertriglyceridemic waist’ provides better prediction for glycemic control than ATP definition.

Journal ArticleDOI
TL;DR: Antiplatelet therapy, and low-dose acetylsalicylic acid (ASA) in particular, is recommended in hypertensive patients with previous cardiovascular events and is considered in hypertension patients with reduced renal function or a high cardiovascular (CV) risk, provided blood pressure is well-controlled.
Abstract: Antiplatelet therapy, and low-dose acetylsalicylic acid (ASA) in particular, is recommended in hypertensive patients with previous cardiovascular events and is considered in hypertensive patients with reduced renal function or a high cardiovascular (CV) risk, provided blood pressure is well-controlled. Acetylsalicylic acid is not recommended in low-to-moderate risk hypertensive patients in whom absolute benefit and harm are equivalent. Further trials evaluating antithrombotic therapy including newer agents in hypertension are needed. Women at high and moderate risk of pre-eclampsia are advised to take a low dose of ASA daily from 12 weeks of gestation until delivery. In addition to their lipid-lowering effects, statins induce a small blood pressure reduction. The 2013 European Society of Hypertension (ESH)/European Society of Cardiology (ESC) guidelines recommend using statin therapy in hypertensive patients at moderate-to-high CV risk to achieve the target low-density lipoprotein (LDL) cholesterol value <3 mmol/l (115 mg/dl). For individuals with manifest CV disease or at very high CV risk, a more aggressive LDL target of <1.8 mmol/l (70 mg/dl) is recommended.


01 Jan 2014
TL;DR: In this paper, the authors evaluated the use of home blood pressure monitoring (HBPM) in hypertensive subjects examined during a crosssectional general population survey (Czech post-MONICA).
Abstract: a b s t r a c t Background: Home blood pressure monitoring (HBPM) is recommended for hypertensive patients as a tool to improve both blood pressure (BP) control and compliance with treatment. Methods: We evaluated the use of HBPM in hypertensive subjects examined during a crosssectional general population survey (Czech post-MONICA). Models predicting the availability and use of HBPM were constructed using univariate and multivariate logistic regression. Results: Of 449 treated hypertensive patients (mean age 63.2 years, 52.1% women), 250 (55.7%) reported that they had a device for BP monitoring available at home. The factors associated with HBPM availability were older age, university education, marital status, longer duration of hypertension and nonsmoking. Of the 250 subjects with HBPM available, 40% used HBPM regularly (at least once a week), and this ratio increased with the number of antihypertensive drugs taken (monotherapy 30%, dual combination 43%, combination of 3 drugs 48%; ptrend = 0.028). BP control was similar in those using HBPM regularly and those who used HBPM irregularly or did not use it at all (54.5 vs. 49.7%; p = 0.52). Conclusion: HBPM is available to more than a half of treated hypertensive patients from the general population. However, only minority of the patients perform home blood pressure measurement regularly.

Journal ArticleDOI
TL;DR: The COLM study, published in this issue of Journal of Hypertension, is a prospective, randomized, open-label, blinded-endpoint study in elderly Japanese hypertensive patients with a history of cardiovascular disease or cardiovascular risk factors, and does not confirm the unexpected results of the ACCOMPLISH study.
Abstract: A total of 70–80% of patients require a combination of antihypertensive drugs to achieve goal blood pressure. The current European Society of Hypertension/European Society of Cardiology (ESH/ESC) guidelines [1] suggest initiating drug treatment either with a single agent or with a combination of two drugs. The latter approach is recommended particularly in patients with marked blood pressure (BP) elevations, or in individuals with high or very high cardiovascular risk. According to the current European guidelines [1], combinations of an angiotensin receptor blocker with a calcium antagonist or a thiazide diuretic belong to the preferred drug combinations. ACCOMPLISH (Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension) [2] is so far the only trial directly comparing two fixed combinations in all patients, finding significant superiority of the ACE inhibitor benazepril plus the calcium antagonist amlodipine over benazepril plus hydrochlorothiazide. There was a 19.6% relative risk reduction of primary outcome event in the benazepril-amlodipine group (hazard ratio 0.80; 95% confidence interval 0.72–0.90; P< 0.001). These unexpected results deserve to be replicated. The COLM (Combinations of OLMesartan) study, published in this issue of Journal of Hypertension, is a prospective, randomized, open-label, blinded-endpoint study in elderly Japanese hypertensive patients with a history of cardiovascular disease or cardiovascular risk factors combining olmesartan with a calcium channel blocker (amlodipine 2.5–5mg/day or azelnidipine 8–16mg/day) or olmesartan with a low-dose diuretic (trichlormethiazide 1 mg, hydrochlorothiazide 12.5 mg, or indapamide 1 mg, and other diuretics) [3]. There was no significant difference in cardiovascular events between the two arms. In other words, the COLM study does not confirm the unexpected results of the ACCOMPLISH study.