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März W, Schmidt N, an Haack I, Dressel A, Grammer TB, Kleber ME, Baessler A, Beil FU, Gouni-Berthold I, Julius U, Kassner U, Katzmann JL, Klose G, König C, Koenig W, Koschker AC, Laufs U, Merkel M, Otte B, Parhofer KG, Hengstenberg W, Schunkert H, Stach-Jablonski K, Steinhagen-Thiessen E, Olivier CB, Hahmann H, Krzossok S, Vogt A, Müller-Wieland D, Schatz U. The German CaRe high registry for familial hypercholesterolemia - Sex differences, treatment strategies, and target value attainment. Atheroscler Plus 2023; 53:6-15. [PMID: 37434912 PMCID: PMC10331285 DOI: 10.1016/j.athplu.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/01/2023] [Accepted: 06/01/2023] [Indexed: 07/13/2023]
Abstract
Background and aims Familial hypercholesterolemia (FH) is among the most common genetic disorders in primary care. However, only 15% or less of patients are diagnosed, and few achieve the goals for low-density lipoprotein cholesterol (LDL-C). In this analysis of the German Cascade Screening and Registry for High Cholesterol (CaRe High), we examined the status of lipid management, treatment strategies, and LDL-C goal attainment according to the ESC/EAS dyslipidemia guidelines. Methods We evaluated consolidated datasets from 1501 FH patients diagnosed clinically and seen either by lipid specialists or general practitioners and internists. We conducted a questionnaire survey of both the recruiting physicians and patients. Results Among the 1501 patients, 86% regularly received lipid-lowering drugs. LDL-C goals were achieved by 26% and 10% of patients with atherosclerotic cardiovascular disease (ASCVD) according to the 2016 and 2019 ESC/EAS dyslipidemia guidelines, respectively. High intensity lipid-lowering was administered more often in men than in women, in patients with ASCVD, at higher LDL-C and in patients with a genetic diagnosis of FH. Conclusions FH is under-treated in Germany compared to guideline recommendations. Male gender, genetic proof of FH, treatment by a specialist, and presence of ASCVD appear to be associated with increased treatment intensity. Achieving the LDL-C goals of the 2019 ESC/EAS dyslipidemia guidelines remains challenging if pre-treatment LDL-C is very high.
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Affiliation(s)
- Winfried März
- D•A•CH Gesellschaft Prävention von Herz-Kreislauf-Erkrankungen e.V., Hamburg, Germany
- V. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Germany
- Klinisches Institut für Medizinische und Chemische Labordiagnostik, Medizinische Universität Graz, Graz, Austria
- Synlab Akademie, Synlab Holding Deutschland GmbH, Mannheim und Augsburg, Germany
| | - Nina Schmidt
- D•A•CH Gesellschaft Prävention von Herz-Kreislauf-Erkrankungen e.V., Hamburg, Germany
| | - Ira an Haack
- D•A•CH Gesellschaft Prävention von Herz-Kreislauf-Erkrankungen e.V., Hamburg, Germany
| | - Alexander Dressel
- D•A•CH Gesellschaft Prävention von Herz-Kreislauf-Erkrankungen e.V., Hamburg, Germany
| | - Tanja B. Grammer
- V. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Germany
- Mannheim Institute of Public Health, Sozial- und Präventivmedizin, Medizinische Fakultät Mannheim, Universität Heidelberg, Germany
| | - Marcus E. Kleber
- V. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Germany
- SYNLAB MVZ Humangenetik Mannheim, Mannheim, Germany
| | - Andrea Baessler
- Department of Internal Medicine II, University Hospital Regensburg, Germany
| | - F. Ulrich Beil
- Universitätsklinikum Hamburg Eppendorf, Ambulanzzentrum, Hamburg, Germany
| | - Ioanna Gouni-Berthold
- Polyclinic for Endocrinology, Diabetology and Preventive Medicine, University of Cologne, Cologne, Germany
| | - Ulrich Julius
- Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus an der Technischen Universität, Dresden, Germany
| | - Ursula Kassner
- Zentrum für Innere Medizin mit Gastroenterologie und Nephrologie, Lipidambulanz Charité Berlin, Germany
| | - Julius L. Katzmann
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Germany
| | - Gerald Klose
- Gemeinschaftspraxis für Innere Medizin, Gastroenterologie und Kardiologie Beckenbauer & Maierhof, Bremen, Germany
| | - Christel König
- Klinik für Innere Medizin, Lipidambulanz, Klinikum Links der Weser, Bremen, Germany
| | - Wolfgang Koenig
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Ann-Cathrin Koschker
- Medizinische Klinik und Poliklinik I, Endokrinologie und Diabetologie, Universität Würzburg, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Germany
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universität des Saarlands, Homburg, Germany
| | | | - Britta Otte
- Medizinische Klinik D, Lipidambulanz, Universitätsklinikum Münster, Germany
| | - Klaus G. Parhofer
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany
| | - Wibke Hengstenberg
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Heribert Schunkert
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | | | | | - Christoph B. Olivier
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Stefan Krzossok
- Zentrum für Nieren- und Hochdruckerkrankungen, Wuppertal, Germany
| | - Anja Vogt
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany
| | - Dirk Müller-Wieland
- Medizinische Klinik I - RWTH Aachen m.S, kardiometabolische Prävention, Germany
| | - Ulrike Schatz
- Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus an der Technischen Universität, Dresden, Germany
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Krzossok S, Braun C, Weiss E, Hoeger S, Schnuelle P, Benck U, Birck R, Krämer BK, Göttmann U. Effects of N-acetylcysteine on renal hemodynamics in contrast media-induced nephropathy. Kidney Blood Press Res 2011; 34:125-34. [PMID: 21335974 DOI: 10.1159/000324168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 01/07/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND N-acetylcysteine (NAC) has been proposed to prevent radiocontrast nephropathy in high-risk patients. METHODS The effect of single-dose and prolonged administration of NAC before application of either the ionic, high-osmolar radiocontrast agent diatrizoate sodium (DTZ) or the nonionic, low-osmolar radiocontrast agent iohexol (IOH) in a rat model combining uninephrectomy, salt depletion, and administration of indomethacin was explored. Arterial blood pressure and total, cortical, and medullary blood flow were continuously recorded in anesthetized Sprague-Dawley rats. RESULTS NAC had no effect on renal hemodynamics in control rats. Both DTZ and IOH induced biphasic changes in renal blood flow and cortical renal blood flux and persistently reduced medullary blood flux. Neither single-dose nor prolonged administration of NAC prevented the hemodynamic changes following administration of DTZ or IOH, respectively. Acute prophylactic administration of NAC prevented increased urinary ET excretion after injection of IOH and, to a smaller degree, of DTZ. Both an ionic, high-osmolar (DTZ) and a nonionic, low-osmolar (IOH) radiocontrast agent induce marked changes in renal hemodynamics in salt-depleted rats treated with indomethacin. CONCLUSIONS Renal perfusion is not affected by NAC application in a model of experimental contrast nephropathy in rats. Other effects of NAC might thus account for the presumed renoprotective properties.
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Affiliation(s)
- Stefan Krzossok
- Fifth Medical Department, Nephrology/Endocrinology/Rheumatology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, Mannheim, Germany
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Schnuelle P, Gottmann U, Köppel H, Brinkkoetter PT, Krzossok S, Weiss J, Schmitt W, Yard BA, Schwarzbach MHM, Post S, van der Woude FJ, Birck R. Comparison of early renal function parameters for the prediction of 5-year graft survival after kidney transplantation. Nephrol Dial Transplant 2006; 22:235-45. [PMID: 17000734 DOI: 10.1093/ndt/gfl530] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Early graft function (EGF) has an enduring effect on the subsequent course after kidney transplantation. This study compares quantitative parameters of EGF for the prediction of graft survival. METHODS We involved 300 consecutive transplant recipients from deceased donors from 1989 to 2005. Urine output during 24 h post-transplant (UO), and serum creatinine after 1 week (Cr7) were taken for explanatory variables. We generated Kaplan-Meier (K-M) estimates of graft survival, by quintiles of the explanatory variable. Cox regression was applied to control for various recipient factors. RESULTS K-M survival estimates indicate a threshold effect of UO and Cr7, which can dissect the risk of graft failure. The thresholds referring to the 2nd quintile correspond to a UO >630 ml and a Cr7 <2.5 mg/dl and were associated with a proportional hazard ratio of 0.52 (95% CI 0.33-0.84) and 0.34 (95% CI 0.18-0.65), respectively. Combining both of the parameters predicted a 5-year graft survival probability >90%, according to a hazard ratio of 0.21 (95% CI 0.09-0.46). Requirement of dialysis post-transplant lost its discriminatory power and was not a significant explanatory variable in the multivariate analysis. CONCLUSION Routine parameters for monitoring of EGF display a threshold effect allowing accurate prediction of 5-year graft survival at the earliest point in time. The quantitative threshold levels for an optimum discriminatory power require validation in a larger, preferably multicentre database.
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Affiliation(s)
- Peter Schnuelle
- University Hospital Mannheim, Vth Medical Clinic, Theodor-Kutzer Ufer 1-3, 68135 Mannheim, Germany.
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Krzossok S, Benck U, van der Woude FJ, Braun C. Disseminierte intravasale Gerinnung, Perimyokarditis und bilaterales Pleuraempyem bei adultem Still-Syndrom. Dtsch Med Wochenschr 2004; 129:2535-7. [PMID: 15543470 DOI: 10.1055/s-2004-835297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
HISTORY A 21-year-old man was admitted to the hospital because of high fever, arthralgias and myalgias. One week before he was treated with penicillin G orally because of cough and sore throat. PHYSICAL EXAMINATION The critically ill patient presented with a red throat and cervical lymphadenopathy. Lung auscultation revealed reduced respiratory sounds at both base, heart auscultation revealed a pericardial friction rub. Dermatologic examinations were normal. INVESTIGATIONS Laboratory findings were notable for anemia, thrombopenia and leukocytosis, disseminated intravascular coagulation and markedly elevated CRP (309 mg/l). Electrogram showed inferior and lateral ST segment depression. Echocardiography showed pericardial effusion. Chest CT scan revealed bilateral pleural effusion, a left-sided small infiltrate and enlarged mediastinal lymph nodes. Abdominal ultrasound confirmed hepatosplenomegaly and ascites. TREATMENT AND CLINICAL COURSE A diagnosis of parapneumonic bilateral pleural empyema, perimyocarditis and disseminated intravascular coagulation was made. Despite institution of empiric antibiotic therapy, no clinical improvement was observed. After exclusion of infectious, autoimmune or malignant disease, clinical and laboratory data, especially marked hyperferritinemia, helped to establish the diagnosis of adult-onset Still's disease. Immunosuppressive treatment with prednisolone and azathioprin resulted in remission. CONCLUSION Adult-onset Still's disease is a rare inflammatory disorder of unknown origin, which may affect multiple organs. The diagnosis is based on a diagnostic score, which includes a number of clinical and laboratory findings, published by Yamaguchi in 1992. Marked hyperferritinemia represents an additional diagnostic clue to the disease.
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Affiliation(s)
- S Krzossok
- V. Medizinische Klinik (Nephrologie/Endokrinologie/Rheumatologie), Universitätsklinikum Mannheim, Germany
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Krzossok S, Birck R, Koeppel H, Schnülle P, Waldherr R, van der Woude FJ, Braun C. Treatment of proteinuria with low-molecular-weight heparin after renal transplantation. Transpl Int 2004; 17:468-72. [PMID: 15322745 DOI: 10.1007/s00147-004-0743-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2003] [Revised: 02/12/2004] [Accepted: 03/18/2004] [Indexed: 11/25/2022]
Abstract
The development of nephrotic-range proteinuria after renal transplantation is an unfavourable prognostic factor for graft survival. In contrast to that in other nephropathies, the role of renin-angiotensin blockade in kidney transplantation is less well defined, and its anti-proteinuric effect is markedly reduced in the presence of segmental glomerulosclerosis. Here, we describe two patients who developed severe proteinuria after renal transplantation, despite effective blood pressure control with an ACE inhibitor. Histological changes were consistent with IgA-nephropathy and focal segmental glomerulosclerosis. Both patients were treated with low-molecular-weight heparin in addition to pre-existing ACE inhibition. This regimen led to a significant and long-lasting reduction of proteinuria. Our data suggest that low-molecular-weight heparin possesses strong renoprotective properties, thus confirming previous data from experimental nephropathies. This approach might represent a promising new strategy for treatment of proteinuria after kidney transplantation.
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Affiliation(s)
- Stefan Krzossok
- Fifth Medical Clinic, Nephrology/Endocrinology/Rheumatology, University Hospital of Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
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Abstract
BACKGROUND Contrast nephropathy is associated with increased in-hospital morbidity and mortality and leads to extension of hospital stay in patients with chronic renal insufficiency. Acetylcysteine seems to be a safe and inexpensive way to reduce contrast nephropathy. We aimed to assess the efficacy of acetylcysteine to prevent contrast nephropathy after administration of radiocontrast media in patients with chronic renal insufficiency. METHODS We did a meta-analysis of randomised controlled trials comparing acetylcysteine and hydration with hydration alone for preventing contrast nephropathy in patients with chronic renal insufficiency. The trials were identified through a combined search of the BIOSIS+/RRM, MEDLINE, Web of Science, Current Contents Medizin, and The Cochrane Library Databases. We used incidence of contrast nephropathy 48 h after administration of radiocontrast media as an outcome measure. FINDINGS Seven trials including 805 patients were eligible according to our inclusion criteria and were analysed. Overall incidence of contrast nephropathy varied between 8% and 28%. Since significant heterogeneity was indicated by the Q statistics (p=0.016) we used a random-effects model to combine the data. Compared with periprocedural hydration alone, administration of acetylcysteine and hydration significantly reduced the relative risk of contrast nephropathy by 56% (0.435 [95% CI 0.215-0.879], p=0.02) in patients with chronic renal insufficiency. Meta-regression revealed no significant relation between the relative risk of contrast nephropathy and the volume of radiocontrast media administered or the degree of chronic renal insufficiency before the procedure. INTERPRETATION Compared with periprocedural hydration alone, acetylcysteine with hydration significantly reduces the risk of contrast nephropathy in patients with chronic renal insufficiency. The relative risk of contrast nephropathy was not related to the amount of radiocontrast media given or to the degree of chronic renal insufficiency before the procedure.
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Affiliation(s)
- Rainer Birck
- Fifth Department of Medicine, University Hospital Mannheim, Mannheim, Germany.
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Birck R, Krzossok S, Knoll T, Braun C, van Der Woude FJ, Rohmeiss P. Preferential COX-2 inhibitor, meloxicam, compromises renal perfusion in euvolemic and hypovolemic rats. Exp Nephrol 2000; 8:173-80. [PMID: 10810234 DOI: 10.1159/000020665] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Nonsteroidal anti-inflammatory drugs can impair renal perfusion through inhibition of cyclooxygenase (COX)-mediated prostaglandin synthesis. We investigated the influence of the preferential COX-2 inhibitor, meloxicam (MELO), on renal hemodynamics in eu- and hypovolemic rats compared to the nonselective COX inhibitor indomethacin (INDO). The hypovolemic state was obtained in rats by three daily injections of furosemide (2 mg/kg i.p.) followed by a sodium-deficient diet for 7 days. In euvolemic rats (n = 6) neither INDO (5 mg/kg i.v.) nor MELO (1 or 2 mg/kg i.v.) influenced mean arterial blood pressure (MAP) or impaired renal (RBF) and cortical blood flow (CBF). Medullary blood flow (MBF) decreased after INDO (18%; p<0.05), and dose-dependently after MELO (1 mg, 10%; 2 mg, 18%; p<0.05). In hypovolemic rats (n = 6) INDO and MELO had no effect on MAP. RBF and CBF were reduced after INDO (11 or 20%; p<0. 05), but showed no changes after MELO. INDO induced a decrease in MBF (22%; p<0.05) which was less pronounced after MELO (12%; p <0.05). In conclusion the preferential COX-2 inhibitor MELO compromized renal perfusion in the outer medulla both in eu- and hypovolemic animals.
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Affiliation(s)
- R Birck
- 5th Department of Medicine, University Hospital Mannheim, Faculty of Clinical Medicine, University of Heidelberg, Mannheim, Germany.
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