UNLABELLED Atherosclerosis is a systemic disease of blood vessels which in most of the cases affects two or three vascular beds. The occurrence and development of atherosclerotic disease is accelerated by multiple risk factors among which the significant role has arterial hypertension and diabetes mellitus. AIM of this article is to evaluate presence of hypertension and diabetes mellitus type 2 in patients with polyvascular atherosclerotic disease and compare them to those who have isolated disease of one vascular bed. MATERIAL AND METHODS we enrolled total of 160 consecutive patients. Patients were divided into 4 groups, in relation to the type of their atherosclerotic disease. COR-group included patients with coronary atherosclerotic disease, CAR-IF group included patients with carotid and iliac-femoral atherosclerotic disease, COR-IF group consists of patients with coronary and iliac-femoral atherosclerotic disease, and COR-CAR-IF group consists of patients with atherosclerotic disease in three vascular beds: coronary, carotid and iliac-femoral. We followed clinical variables: age, gender, arterial hypertension, tobacco smoking, total cholesterol and diabetes mellitus with focus on arterial hypertension and diabetes mellitus. RESULTS we had significant percentage of patients with arterial hypertension in all four groups in relation to those with normal blood pressure. Hypertension in male subjects was significantly higher in those with polyvascular disease i.e. COR-CAR-IF, and COR-IF groups, compared to monovascular disease i.e. COR group, (p < 0.05). In females the prevalence of hypertension was significantly higher in COR-CAR-IF and COR-IF groups, (< 0.05). Males had higher systolic values in the COR-CAR-IF group compared to other groups, but only signif. differ. was between COR-CAR-IF group vs. CAR-IF group, (p < 0.05). In females we found signif. differ. in systolic values in COR-CAR-IF group compared to COR group, p < 0,05. In diastolic values we found no signif. differ. between groups. The significant percentage of diabetics was in COR-CAR-IF group (77.5%), and the difference to other groups was statistically significant, p < 0.05. We found significant percentage of diabetics in COR-CAR-IF group (77.5%), and the difference between the diabetics versus non-diabetics was statistically significant. The largest percentage of diabetics both men (76.1%) and women (84.2%) belonged to the patients with polyvascular disease i.e. COR-CAR-IF group respondents. CONCLUSIONS prevalence of arterial hypertension and type 2 diabetes mellitus was statistically higher in individuals with polyvascular atherosclerotic disease.

The aim of this study was to analyze (i) ratios between pro-inflammatory cytokines interleukin 6 (IL-6), interleukin 1 (IL-1), tumour necrosis factor alpha (TNF-alpha) and anti-inflammatory cytokine interleukin 10 (IL-10) in patients with acute myocardial infarction (AMI) and stable angina pectoris (ii) as well as correlation between IL-6 and IL-10 in AMI and (iii) correlation between IL-6 and lipoproteins in AMI.The total of 71 patients were enrolled in this study, 41 of them with AMI (study group) and 30 with stable angina pectoris (control group). The concentrations of cytokines and lipoproteins were measured from blood samples. Pro-inflammatory to anti-inflammatory cytokine ratios were calculated by dividing concentrations of pro-inflammatory cytokines with IL-10. In statistical analyses we used descriptive statistics, normality tests and analysis of correlation.IL-6: IL-10 ratio is significantly higher in AMI than in stable angina (P < 0,001), TNF-alpha: IL-10 is also higher in study group but the difference is not significant. We found positive linear correlation between IL-6 and IL-10 (r =0,43; p = 0,015) and negative linear correlation between IL-6 and high density lipoprotein HDL (r = -0,47; p= 0,008) in AMI.IL-6: IL-10 ratio is higher in AMI than in stable angina. There is linear correlation between IL-6 and IL-10 and IL-6 and HDL in AMI.

Background: The treatment of subclinical hyperthyroidism (SH) is still controversial since there are no huge clinical trials that tried to assess the effects of therapy of SH. Aim: We aimed to determine whether a frequency and symptoms of cardiovascular abnormalities commonly associated with hyperthyroidism will reduce after the treatment with methimazole in a cohort of patients with established and untreated SH. Methods: We prospectively evaluated 29 patients with recently diagnosed SH that were naive to any treatment directed against over production of thyroid hormones. We evaluated each patient by assesing the rate of specific symptoms, clinical examination, electrocardiography, heart ultrasonography and determination of thyroid hormones and antibodies. Results: The mean age in our sample was 49±13 years with 21 (79.32%) women. The average duration of methimazole treatment was 7±1 months. Mean values of all thyroid hormones and thyroid antibodies significantly declined after the treatment (p<0.05). A significant decrease in frequency of palpitation, irregular heart beat and dyspnoea was observed in patients after the treatment (p<0.001). There was no difference in mean values of diastolic pressure before and after the treatment, however systolic pressure and heart rate declined significantly after the treatment (p<0.0001). A clear reduction in LV mass, interventricular septum thickness and thickness of posterior wall of LV was demonstrated as a response to treatment of subclinical hyperthyroidism (p<0.001). Supraventricular premature beats and sinus tachycardia completely disappeared after the treatment (p<0.002). Although there was a clear tendency for a reduction in frequencies of paroxysmal supraventricular tachycardia, atrial fibrilation and right bundle branch block, it was not statistically significant. Conclusion: Cardiovascular abnormalities associated with SH are significantly reduced after treatment with methimazole and achieving euthyroidism. Our results indicate that treatment of this syndrome is justified as it may reverse potentially harmful effects on cardiovascular system.

Introduction: sudden cardiac death (SCD) is an unexpected natural death due to cardiac causes in a short time period in a person with or without preexisting heart disease. Incidence of SCD in general population is 1/1000 inhabitants. Aims: to determine the incidence of SCD at a territory of Zivinice municipality. Patients and methods: this study is a prospective examination of SCD by using the data from death certificates, data received from interviews with competent physicians, witnesses and family members. Definition and criteria of SCD by European Society of Cardiologist and American Heart Association from 2001 and use of International Classification of Diseases, version 10, were applied to determine the number of SCD. Results: sudden cardiac death is the single most frequent cause of death in inhabitants of the Živinice municipality. The incidence of SCD at the municipal Živinice was 1 .4 cases per 1000 inhabitants per year. Mean age was 66.3 (±12,6) years; in average, men were 7.2 years younger than women. The risk for SCD was 1.24-fold higher in men than in women. Correlation between the age and numbers of SCD was high (r=0.89; p<0.005). The most frequent risk factors were age, family history of SCD and/or cardiovascular disease and inadequate physical activity; leading conventional risk factor was hypertension. Witnesses of sudden cardiac death were present in 58.0% cases. None of the persons with out-of-hospital SCD received adequate first aid from bystanders. Conclusion: Sudden cardiac death is the single most frequent cause of death among inhabitants of Zivinice municipality; proportion of SCD within all other causes of death was 22.3%. Incidence of SCD however, is not significantly higher when compared to industrialized countries. A risk for sudden cardiac death is significantly higher and directly depends on the presence and number of risk factors.

The aim of this trial was to examine the effects of antihypertensive fixed combination of lisinopril plus hydrochlorothiazide (Lopril H, Bosnalijek dd, Bosnia and Herzegovina) on regression of left ventricular hypertrophy in patients with essential arterial hypertension. We included 297 patients in our trial, aged 54.65+/-9.6 years, with treated or untreated hypertension and with high risk of cardiac events, in an opened trial of therapy based on lisinopril plus hydrochlorothiazide. Patients from five European countries were followed up for a period of 12 weeks. Duration of treatment was 12 weeks. We adjusted daily doses of lisinopril plus hydrochlorothiazide after every clinical examination and recorded adverse effects of drugs. In the beginning and after 12 weeks of treatment, 277 patients (93.2%) underwent 2-dimensional echocardiography and there were 186 patients evaluated for efficacy of treatment on left ventricular hypertrophy (LVH). We recorded a regression of index mass LVH (168.56 vs 161.51 g/m2, P<0.0001), and regression was something more in women vs men. We recorded average reduction of left ventricular mass index for patients with LVH (N=186) by 7.05 g/m2 (4.18%) in all patients, by 6.73 g/m2 (3.93%) in men and 7.27 g/m2 (4,37%) in women. The proportion of patients who attained a regression of left ventricular mass tended to be greater in men (54.55% vs 53.21%). This research has proved regression of LVH in more than 53% patients after using fixed combination of lisinopril plus hydrochlorothiazide.

We aimed to evaluate levels of amino-terminal pro-brain natriuretic peptid (NT-proBNP) in prediction of left ventricular ejection fraction (LVEF) in heart failure patients. Prospective study on 60 consecutive patients with symptoms and signs of heart failure was performed. Blood samples for NT-proBNP analysis was taken from all test subjects and echocardiography was also done in all of them. According to LVEF value, patients were divided into four groups; those with <or=30%, 31 to 39%, 40 to 49% and >or=50%. NT-proBNP values correlated with LVEF value. Regression analysis was used to evaluate how well NT-proBNP values predict LVEF. We used Receiver Operating Characteristic Curve calculation to evaluate diagnostic performance of NT-proBNP in estimation of LVEF. Average value of NT-proBNP in test group was 3191.69+/-642.89 pg/ml (p<0.001). Average value of NT-proBNP decreased with higher LVEF categories with significant (p<0.001) and high negative correlation (r= -0,75). Stepwise multivariate linear regression analysis showed that logarithmic value of NT-proBNP was excellent predictor of LVEF value (p<0.05). Model equation based on regression analysis was LVEF=88.645-15.311 x log (NT-proBNP). Predictive model for LVEF yielded from regression analysis had sensitivities of 98% and 81%, specificities of 20% and 90%, positive predictive values of 86% and 78% and negative predictive values of 67% and 92% for predicting patients with LVEF<50% and LVEF<40%, respectively. There was negative linear correlation between NT-proBNP and LVEF. NT-proBNP was excellent predictor of LVEF value (p<0.05).

The aim of this study was to evaluate the presence of atherosclerotic plaque of head and neck blood vessels and to determine the dynamics of circulation through the brain blood vessels in patients with systemic lupus erythematosus (SLE). In 35 patients with SLE aged 37.67+/-9.96 and whose disease lasted 3.8+/-4.51 years, Doppler carotid ultrasonography was used to identify the presence of intima-media thickness or atherosclerotic plaque. Brain perfusion scintigraphy was done in 15 out of 35 patients in order to evaluate the dynamics in circulation through carotid and cerebral media arteries. Measured by Doppler ultrasound, 2/35 of examined lupus patients had a plaque and the 2/35 had an intimal-medial thickness. The results of perfusion scintigraphy in 15 examined patients out 35 with SLE showed that 5/15 had mild circulatory changes in carotidogram. 4/15 patients had mild changes in cerebra media arteries circulation, 1/15 had severe changes in carotid circulation and 5/15 patients had normal brain scintigraphy finding. Some of the patients with SLE have atherosclerotic changes and only the early detection of atherosclerosis may provide an opportunity for therapeutic intervention.

Smoking causes decrease of HDL-cholesterol (HDL-C) levels and increase of total cholesterol, triglyceride and LDL-cholesterol (LDL-C) levels. Low HDL-C levels and high cholesterol and LDL-C levels are associated with a higher risk for cardiovascular diseases. The aim of this study was to examine the effect of smoking status on serum lipid and lipoproteins levels among patients in family medicine practice. This trial was designed to detect differences in serum total cholesterol, triglyceride, LDL-C and HDL-C levels between smokers and non-smokers. We had placed a limit of 300 patients for data collection. We excluded 195 patients who met excluding criteria (diagnosis of diabetes mellitus, renal and hepatic failure, hypothyroidism; using beta blockers, thiazide diuretics, hormonal replacement therapy and corticosteroids; more than light physical activity; alcohol consumption and obesity), so the sample size included 105 randomly selected patients from Family Medicine Teaching Center Tuzla, mean age 52.05 +/- 11.61 years. Main outcomes were smoking status in all participants and serum total cholesterol, triglyceride, LDL-C and HDL-C levels in smokers and non-smokers. Our results showed that smoking prevalence was 49.52%. Smokers had significantly higher serum total cholesterol (P=0.01), triglyceride (P=0.002) and LDL-C level (P=0.03) and significantly lower HDL-C level (P=0.003) comparing with nonsmokers. There was no significant difference in serum lipid and lipoprotein levels between ex-smokers and never smokers. These results suggest that cigarette smoking adversely affects serum lipid and lipoprotein levels which further increases the risk for cardiovascular morbidity and mortality.

For more than three decades, heart muscle diseases have been classified into primary or idiopathic myocardial diseases (cardiomyopathies) and secondary discorders that have similar morphological appearances, but which are caused by an identifiable pathology such as coronary artery disease or myocardial infiltration (specific heart muscle diseases). In this document, The European Society of Cardiology Working group on Myocardial and Pericardial Diseases presents an update of the existing classification scheme. In this statement define a cardiomyopathies as myocardial discorder in which the heart muscle is structurally and functionally abnormal, in the absence of coronary artery disease, hypertension, valvular disease and congenital heart disease suffitient to cause the observed myocardial abnormality. Cardiomyopathies are gruoped into specific morphological and functional phenotypes; each phenotype is then subclassified into familial and non-familial forms. The aim is to help clinicians look beyond generic diagnostic labels in order reach more specific diagnoses heart muscle diseases.

The aim of this trial was to examine the efficacy and safety of antihypertensive fixed combination lisinopril plus hydrochlorothiazide (Lopril H, Bosnalijek dd) in the treatment of essential arterial hypertension. In our trial we included 297 patients, aged 54.65+/-9.6 years, with treated or untreated hypertension and with high risk of cardiac events, in an opened trial of therapy based on lisinopril plus hydrochlorothiazide. Upon the examination by physicians, patients were divided into three groups in accordance with European Society of Cardiology guidelines for the management of arterial hypertension. Patients from five European countries were followed up for a period of 12 weeks. Duration of treatment was 12 weeks. We adjusted daily doses of lisinopril plus hydrochlorothiazide after every clinical examination and recorded adverse effects of drugs. After 12 weeks of treatment, 288 patients (96%) were evaluated for efficacy, tolerability and safety. In almost 81.5% patients with mild, moderate and severe hypertension, we recorded a reduction in blood pressure to approximately normal values SBP and DBP (140/90 mmHg). Drug-related side-effects occurred in 11 patients (3.66%). The most commonly reported adverse effects associated with lisinopril plus hydrochlorothiazide were cough (5) and dry mouth (5). This research has proved good efficacy of fixed combination lisinopril plus hydrochlorothiazide with more than 97% patients. Based on subjective estimation by patients: this drug improved quality of life in all cases.

T Diastolic dysfunction is very frequent and is actually sign of manifest heart weakness. Over 40% of patients with heart weakness have isolated left ventricular diastolic dysfunction (LVDD). New diagnostics methods as Doppler Echocardiography with close monitoring enables precise and early LVDD diagnose. In all diastolic phases artery hypertension weakens relaxation and left ventricular hypertrophy (LVH) weakens compliance also. The purpose of this study is to demonstrate importance of all LVDD. Doppler echocardiography parameters usage and its important echocardiography characteristic in case of hypertensive patients. This study represents 64 patients with essential hypertension - random sample. Three patients had atrial fibrillation. Besides anamnestic data collection, echocardiography evaluation was undertaken on all patients. For LVDD diagnose following parameters were used: isovolumic relaxation time (IVRT), peak early filling velocity (E), peak atrial filling velocity (A), E/A ratio, DT (deceleration time), left ventricular (LV) mass. Left ventricular hypertrophy (LVH) was verified for 57 patients. Seven hypertensive patients didn't have verified LVH. Comparing patients with LVH with those without LVH differences were observed: patients with LVH had a longer IVRT, lower E/A ratio, A wave growth, IVRT directly correlates with LV mass increase and backward correlation LV mass with E/A was noticed. Among patients with LVH with E/A ratio =or> 1-1,5 and based on transmitral flow we used IVRT duration and pulse Doppler with volume sample over lateral mitral annulus measuring mitral annulus velocity. It appeared that it corresponds with IVRT duration in LVDD evaluation. Patients with atrial fibrillation had considerably extended IVRT that indicates LVDD existence. Patients with left ventricular hypertrophy were older and they have higher left ventricular mass comparing with patients without left ventricular hypertrophy. In case of patients with essential hypertension all above mentioned LVDD parameters have to be defined, specially IVRT duration for determination of LVDD existence in case of all patients with essential hypertension with and without LVH and in case of associated atrial fibrillation presence. It is necessary to tend to, as early as possible, detect LVDD and it's prevention with improved essential hypertension monitoring.

Diagnosis of primarly cardiomypathies refers to genes discorders in chromosomes. Aim of this paper is to show genetics and molecular knowledges published so far. Familiar form hypertrophic cardiomyopathy is hereditable autosomatically dominantly in any of 10 genes that regulate contractile, structural and regulative function with predomination of mutation in gene for heavy chaire of myocardiac beta myosin localized at 14 chromosome (more than 200 mutation). Sporadic forms appears autosomatically recessively as the result of new mutation or as non-genetic form. Familiar dilated cardiomyopathy is associated with mutation more than 10 genes with frequent mutation of genes (beta myosin of heavy chain, cardiac T throponin, phospholamban and cardiospecific free methavinculin genes) and with clinical features that are mainly uknown (associated with peripheral myopathies). Restrictive cardiomyopathy is considered that the idiopathic restrictice cardiomyopathies has, also, hereditable atiology. A lot of the ries explain genes of this cardiomyopathy with predomination of heredithy with autosomatically dominant type (desmoplacin mutation) with variable expression of genes at 14, 1, 2, 3, 17 and 18 chromosome with programmed myocit death-apoptosis.