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Biomedical subjects

István Czuriga

Publications and source records attributed to István Czuriga.

13 recordsLinked to original sources
PubMed2006

[Increase of homocysteine in cardiovascular diseases in Hungary].

UNLABELLED: There are only very few epidemiological data about homocysteine levels in patients suffering from cardiovascular (CV) disease in Hungary, however, homocysteine is a newly recognized, independent risk factor of CV diseases. AIM OF THE STUDY: Therefore, in the present study, data of 1010 East-Hungarian patients with signs of CV disease were analyzed retrospectively for correlation between the level of homocysteine and CV diseases, laboratory parameters, as well as genetic differences. PATIENTS AND METHODS: From the studied patient population a control ("healthy") group has been selected according to the following criteria: lack of previous stroke or stenosis of the carotid arteries or the lower extremities, lack of coronary artery stenosis more than 50%, no previous coronary intervention or an angiography diagnosed progression of the coronary atherosclerosis. RESULTS: The level of homocysteine showed statistically significant negative linear correlation with HDL-cholesterol and the anti-atherogenic ApoAI, and showed a positive correlation with CRP and FXIII activities in the entire patient population. When compared to the control group, homocysteine level was significantly higher in patients with previous stroke or acute myocardial infarction, coronary stenosis, progressive coronary disease, physical inactivity, MTHFR gene polymorphism, low folate or vitamin B12 level in both men and women. In patients with type II diabetes the level of homocysteine was significantly higher only in women. CONCLUSIONS: It can be concluded that the level of homocysteine in patients suffering from various CV diseases is high in Hungary. This may have a prognostic value, and shows that reduction of homocysteine level in these patients may be beneficial.

Adult↗
PubMed2006

[Lowering cholesterol: how low is low enough?].

The mean cholesterol level of the civilized modern humans is above the one considered "physiological", and a biological gradient exists between serum cholesterol level and cardiovascular events. Clinical studies on cholesterol lowering revealed that cardiovascular risk can be lowered in parallel along this gradient, and the "lower is better" rule appears to be supported by the current evidence. LDL cholesterol level should minimally be reduced on average by 50% to approach the "physiological" cholesterol concentration in order to halt the progression of atherosclerosis. Using the initial doses of hydroxymethylglutaryl coenzyme A reductase inhibitors (statins), the first-line lipid lowering drugs, this goal cannot be reached. On the other hand, high doses of statins increase the frequency of adverse events, which should contribute to the common failure of putting patients to their lipid targets in a real-world setting. Consequently, the combination of low dose statins and another cholesterol lowering agent with a mechanism of action different than synthesis inhibition (such as ezetimibe) may be the optimal clinical approach to avoid the dose-dependent adverse events. The ongoing large head-to-head clinical trials will clarify the efficacy and safety of cholesterol lowering combination therapy relative to statins in the reduction of cardiovascular risk.

Anticholesteremic Agents↗
PubMed2005

[Chronic heart failure--the epidemic of the 21st century].

Heart failure represents a major public health problem in the industrialized countries and despite of optimal medical treatment its mortality remains high. The history of its management reflects growth and changes in our understanding of its pathophysiology. In the past, pharmacological treatment of heart failure was aimed only at relieving edema and improving hemodynamics. Today, however, a major aim of treatment is to antagonize the sympathetic nervous system and renin-angiotensin-aldosterone system, to avert harmful effects of neurohormonal activation on the myocardium and peripheral vessels. Currently, the major pharmacological treatments for heart failure are diuretics, ACE inhibitors, beta-blockers and (in NYHA classes III-IV) aldosterone antagonists. Some patients may also require specific treatment with additional drugs (e.g. anti-arrhythmia agents, anticoagulants, or vasodilators) or procedures such as coronary revascularization, or implantable devices such as pacemakers and implantable cardioverter defibrillators, or resynchronization devices. Patients with end-stage heart failure may require cardiac transplantation or ventricular assist devices. This review is summarized the recent practical drug therapy of heart failure and the results of the newer clinical trial.

Adrenergic beta-Antagonists↗
PubMed2005

[Current practice and future perspectives of myocardial stem cell therapy].

Myocardial infarction became more frequent mainly in the developed countries in the past decades. Beside the pharmacological (thrombolysis, beta-blockers, ACE-inhibitors, antiplatelet- and lipid-lowering drugs, etc.) and interventional (percutaneous coronary intervention, intraaortic balloon pump, resynchronization therapy, left ventricular assist devices etc.) procedures the quality of life of patients and the morbidity and mortality data were improved. However we experience development of heart failure following myocardial infarction because of significant cell loss and left ventricular remodeling. Until now there was not any therapeutic procedure affecting via cardiomyocyte renewal, but in the last 5 years the myocardial stem cell therapy was introduced to human clinical phase. In this review the authors summarized the general features of stem cells, why these cells are in the focus of the interest and their preclinical and clinical applications in myocardial infarction. Promising issues suggests, that intramyocardial implantation of autologous bone marrow derived stem cells become a new therapeutic modality in treatment of myocardial infarction. The stem cell therapy and regenerative medicine would open new perspectives in cardiology. However it is very important to remark, that this, as every medical procedure can be dangerous and can cause side effects. A lot of molecular and cellular mechanism of cell therapy is not clear at present, that's why we should be careful with this opportunity holding in our hands. We have to plan multicenter clinical trials to evaluate the long term safety and efficacy of the procedure.

Angioplasty, Balloon, Coronary↗
PubMed2005

Changes of cerebral hemodynamics in hypertensives during physical exercise.

BACKGROUND AND PURPOSE: Previously, 30 untreated hypertensive patients were investigated by transcranial Doppler (TCD) monitoring during physical exercise, and changes of hemodynamic parameters were compared with those of age matched healthy subjects. After 3-year antihypertensive (AHT) treatment, these hypertensives were investigated again. The aim of this study was to compare the cerebral hemodynamic changes in the regularly treated and noncompliant (untreated) hypertensives during ergometer cycling. METHODS: Nineteen of 30 previously untreated hypertensive patients could be investigated again using the same method as before. Eleven were regularly treated (treated hypertensive [T-HT] group), and 8 did not take their AHT medications due to lack of compliance (noncompliant hypertensive [NC-HT] group). Blood pressure, heart rate, end-tidal CO2 (etCO2; Capnogard capnograph), and bilateral middle cerebral artery mean blood flow velocity (MV) were continuously monitored during ergometer cycling according to the World Health Organization protocol. Values of 2-minute loading were analyzed. RESULTS: Median loading time did not differ significantly between the T-HT and NC-HT groups. After 2 minutes of cycling in treated patients, the ratio of MV and etCO changes (DeltaMV/DeltaetCO2) showed similar values as before therapy (P = .38), whereas in noncompliant patients, a further worsening of the ratio of DeltaMV/DeltaetCO2 could be observed (P = .04). CONCLUSION: The decrease of arteriolar vasodilation (ie, the ratio of DeltaMV/DeltaetCO2) could be demonstrated in the NC-HT group after 3 years. TCD combined with ergometer cycling is a useful method for evaluation of cerebral hemodynamic changes after AHT therapy.

Adult↗
PubMed2004

[Beta-adrenergic receptor blockers in clinical practice].

Discovery of beta receptor system and the class of beta-adrenergic receptor antagonists in the last century has been one of the most important developments in cardiovascular pharmacotherapy. A non-cardioselective beta blocker (propranolol) was introduced in the therapy in the early 1960s. Later, the second generation beta1 selective blockers and finally the third generation blockers (with vasodilator property) appeared on the market. Beta-adrenergic receptor antagonists have become widely used in cardiovascular therapy for the last decades. They were introduced for the treatment of angina pectoris and arrhythmias and later hypertension and there has been a continuing progress in the treatment of several heart diseases (including congestive heart failure which was contraindicated earlier). The recent clinical indications and practical considerations of beta-blockers are summarized in this review.

Adrenergic beta-Antagonists↗
PubMed2003

[Current views on stunned and hibernating myocardium].

A short review is presented about similarities and dissimilarities in pathophysiology of prompt reversible ischemia, stunned and hibernating myocardium. Definitions of these entities are given. Characteristics of clinical appearance, diagnostic procedures, natural history, prognosis and therapeutic modalities of stunned and hibernating myocardium are reviewed, respectively. Interrelations between prompt reversible ischemia, stunned, hibernating myocardium and ischemic preconditioning are briefly reported.

Humans↗
PubMed2003

Metoprolol CR/XL in postmyocardial infarction patients with chronic heart failure: experiences from MERIT-HF.

BACKGROUND: The benefit of beta-blockers post-myocardial infarction (MI) was established in the late 1970s. Major advances in the treatment of MI have since occurred. However, patients with chronic heart failure (CHF) were excluded from those trials. The purpose of this study was to assess the effect of beta-blockers in post-MI patients with CHF receiving contemporary management. METHODS: This was a prespecified subgroup analysis of a double-blind, randomized trial: the Metoprolol CR/XL Randomized Intervention Trial in Heart Failure (MERIT-HF). Patients with CHF in New York Heart Association class II to IV with an ejection fraction (EF) < or =0.40 and a history of being hospitalized for an acute MI (n = 1926) were randomized to metoprolol succinate controlled release/extended release (CR/XL) versus placebo. Mean EF was 0.28, and the mean follow-up was 1 year. RESULTS: Metoprolol CR/XL reduced total mortality by 40% (95% CI 0.20-0.55, P =.0004), and sudden death by 50% (95% CI 0.26-0.66, P =.0004). The combined end point of all-cause mortality/hospitalization for worsening CHF was reduced by 31% (95% CI 0.16-0.44, P <.0001), and cardiac death/nonfatal acute MI by 45% (95% CI 0.26-0.58, P <.0001). A post-hoc analysis showed that the outcome in patients with earlier revascularization (44%) and outcome in those with more severe CHF (20%) was similar to the entire post-MI population. CONCLUSIONS: In post-MI patients with symptomatic CHF, beta-blockade continues to exert a profound reduction in mortality and morbidity in the presence of contemporary management that includes early and late revascularization, angiotensin-converting enzyme inhibitors, aspirin, and statins.

Adrenergic beta-Antagonists↗
PubMed2002

[Secondary prevention after myocardial infarction].

The management of acute myocardial infarction has been revolutionized in the past decade. Advances in pharmacological and mechanical reperfusion therapy have improved the survival of patients who experience myocardial infarction. Although revascularisation techniques have been shown to reduce infarct size and in-hospital mortality, patients recovering from myocardial infarction are still at increased risk for reinfarction, congestive heart failure, and sudden death. Despite impressive technological advances, lifestyle modification and pharmacological interventions remain the key components of secondary prevention after myocardial infarction. Although the concept of secondary prevention of reinfarction and death has been investigated vigorously for several decades, preventive therapy has been seriously underused by physicians. The aim of this paper is to provide a comprehensive, evidence-based overview of secondary prevention postmyocardial infarction clinical trials, in the hope of improving the utilization of effective therapies in patients with coronary heart disease.

Adrenergic beta-Antagonists↗