Challenging atherosclerosis, aggressiveness versus timing?

Authors: Jan Piťha
Authors‘ workplace: Laboratoř pro výzkum aterosklerózy, Centrum experimentální medicíny, IKEM, Praha
Published in: AtheroRev 2016; 1(1): 14-18
Category: Reviews


Advanced atherosclerotic changes can often resist even to aggressive treatment. Women in the population, diabetic patients and patients with renal insufficiency share the factor of optimal timing of treatment of atherosclerosis. In women transition to menopause could be optimal period for intervention. In diabetic patients crucial could be intensively intervene already in persons with moderately elevated fasting glycaemia. In patients with renal insufficiency the optimal start of statin treatment should be before hemodialysis.

Key words:
atherosclerosis – diabetes mellitus – timing of management – renal insufficiency – perimenopausal women


1. Kannel WB, Schatzkin A. Sudden death: lessons from subsets in population studies. J Am Coll Cardiol 1985; 5(6 Suppl): 141B-149B.

2. Zdravotnická ročenka České republiky. Ústav zdravotnických informací a statistiky ČR: Praha. Dostupné z WWW:

3. Willeit J, Kiechl S, Oberhollenzer F et al. Distinct risk profiles of early and advanced atherosclerosis: prospective results from the Bruneck Study. Arterioscler Thromb Vasc Biol 2000; 20(2): 529–537.

4. Kiechl S, Willeit J. The natural course of atherosclerosis. Part II: vascular remodeling. Bruneck Study Group. Arterioscler Thromb Vasc Biol 1999; 19(6): 1491–1498.

5. Kiechl S, Willeit J. The natural course of atherosclerosis. Part I: incidence and progression. Arterioscler Thromb Vasc Biol 1999; 19(6): 1484–1490.

6. Nitta K. Clinical assessment and management of dyslipidemia in patients with chronic kidney disease. Clin Exp Nephrol 2012; 16(4): 522–529.

7. Fellstrom BC, Jardine AG, Schmieder RE et al. Rosuvastatin and cardiovascular events in patients undergoing hemodialysis. N Engl J Med 2009; 360: 1395–1407. Erratum in N Engl J Med 2010; 362(15): 1450.

8. Santoro N, Sutton-Tyrrell K. The SWAN song: Study of Women‘s Health Accross the Nation‘s recurring themes. Obstet Gynecol Clin North Am 2011; 38(3): 417–423.

9. Pappa T, Alevizaki M. Endogenous sex steroids and cardio- and cerebro-vascular disease in the postmenopausal period. Eur J Endocrinol 2012; 167(2): 145–156.

10. Pitha J, Králová-Lesná I, Sekerková A et al. Menopausal transition enhances the atherogenic risk of smoking in middle aged women. Int J Cardiol 2013; 168(1): 190–196.

11. Pitha J, Auzký O, Kovář J et al. Změny kardiovaskulárního rizikového profilu žen po menopause (Prague Pre and Post Menopausal Female study). Cor et Vasa 2014; 56: e113 – e117. Dostupné z WWW:

12. Skrha J. Diabetes mellitus-a global pandemic. Keynote lecture presented at the Wonca conference in Prague in June 2013. Eur J Gen Pract 2014; 20(1): 65–68.

13. Skrha J, Ambos A. Can the atherosclerosis prevention targets be achieved in type 2 diabetes? Diabetes Res Clin Pract 2005; 68(Suppl 1): S48-S51.

14. Hermans MP. Non-invited review: prevention of microvascular diabetic complications by fenofibrate: lessons from FIELD and ACCORD. Diab Vasc Dis Res 2011; 8(3): 180–189.

15. Wing RR, Bolin P, Brancati FL et al. Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013; 369(2):145–154. Erratum in N Engl J Med 2014; 370(19): 1866.

16. Hakeem A, Bhatti S, Chang SM. Screening and risk stratification of coronary artery disease in end-stage renal disease. JACC Cardiovasc Imaging. 2014; 7(7): 715–728.

17. Schneider MP, Hübner S, Titze SI et al. Implementation of the KDIGO guideline on lipid management requires a substantial increase in statin prescription rates. Kidney Int 2015; 88(6): 1411–1418.

18. Rysz J, Gluba-Brzózka A, Banach M et al. Should we use statins in all patients with chronic kidney disease without dialysis therapy? The current state of knowledge. Int Urol Nephrol 2015; 47(5): 805–813.

19. Hoi S, Battistella M. Should statins be used to prevent cardiovascular disease in patients on hemodialysis? CANNT J 2014; 24(2): 45–47.

20. Wanner C, Tonelli M. Kidney Disease: Improving Global Outcomes Lipid Guideline Development Work Group Members. KDIGO Clinical Practice Guideline for Lipid Management in CKD: summary of recommendation statements and clinical approach to the patient. Kidney Int 2014; 85(6): 1303–1309.

Angiology Diabetology Internal medicine Cardiology General practitioner for adults
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account