Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Feb 2020
Bradykinin and oxidative stress in patients with hereditary angioedema due to C1 inhibitor deficiency.
Hereditary angioedema (HAE) is a rare autosomal dominant disease caused by genetic dysfunction of C1 inhibitor (C1-INH) due to mutations in the SERPING1 gene. The disorder is mediated mainly by bradykinin. The clinical course of the disease is varied and not related to genetic changes. ⋯ The higher basal and H2O2-induced ROS levels in patients with C1 INH HAE indicate redox imbalance. However, by reducing basal and H2O2-induced ROS levels, bradykinin shows antioxidant action in this disorder.
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Pol. Arch. Med. Wewn. · Feb 2020
ReviewAspirin for primary cardiovascular prevention: why the wonder drug should not be precipitously dismissed.
Primary cardiovascular prevention is the combined set of actions aimed at reducing the likelihood of symptomatic atherosclerotic disease or major adverse cardiovascular events (MACEs) in currently asymptomatic individuals. Older studies on aspirin for primary prevention were positive or neutral as to the primary ischemic endpoint (often represented by MACE), but the reduction in nonfatal ischemic events seemed largely counterbalanced by an increase in bleeding events. The 3 latest large randomized controlled trials on aspirin in primary prevention, all published in 2018, reached basically similar conclusions, leading to an intense debate on whether aspirin therapy is warranted in asymptomatic patients and whether there are subgroups that may benefit. ⋯ Based on a meta‑regression of the benefits and harm of aspirin therapy in primary prevention as a function of the 10‑year risk of MACE, which is an alternative type of pooled analysis of available evidence, we propose a treatment algorithm acknowledging differences among patients and emphasizing the need for an individualized assessment of benefits and risks. Following general preventive measures (physical exercise, smoking cessation, treatment of hypertension and hypercholesterolemia, etc), a tailored approach to aspirin prescription is warranted. When patients are younger than 70 years of age, clinicians should assess the 10‑year cardiovascular risk: when such risk is high and bleeding risk is low, aspirin treatment should still be considered, also taking patients' preferences into account.