Cardiologia Croatica. 2018;13(9-10)

Nenad Lakušić

The exercise test has for decades been an unavoidable non-invasive method in the diagnosis of coronary artery disease. Despite the development of other modern and sophisticated non-invasive and invasive methods for coronary artery disease diagnosis, the exercise test has not lost its place to this day and is usually the first line in the diagnosis of coronary artery disease. This paper gives an overview of the historical development of exercise testing in the world and in Croatia.

Marija Magdalena Jakopović, Anja Ivošević, Marija Stanković, Ingrid Prkačin

Resistant hypertension is the failure to achieve target blood pressure in spite of using a minimum of 3 antihypertensive drugs of different classes, one of which must be a diuretic, at maximal tolerated doses. The prevalence of true resistant hypertension ranges between 7.9-10.0% and is associated with higher risk of kidney and cardiovascular system damage. Treatment of resistant hypertension focuses on lifestyle modifications and pharmacological therapy. Device-based therapies are indicated in patients in whom pharmacological agents failed to control the blood pressure. Evidence suggests beneficial effects of renal sympathectomy on life expectancy and prevention of cardiovascular complications in patients with resistant hypertension with chronic activation of the sympathetic nervous system, such as chronic kidney disease and type 2 diabetes mellitus. In terms of costs, there is no question pharmacoeconomically that effective blood pressure control in resistant hypertension with drugs and new innovative devices therapies is cheaper than treating the consequences of hypertensive target organ damage.

Anja Ivošević, Marija Magdalena Jakopović, Marija Stanković, Ingrid Prkačin

MicroRNA (miRNA) are small non-coding single-strand RNA molecules built from 21-25 nucleotides that regulate gene expression at the post-transcription level. More than a thousand different miRNA are coded in the human genome. During the last few years, it has been found that miRNA are involved in different biological processes such as differentiation, proliferation, and apoptosis of cells. miRNA is part of the pathogenesis of many diseases in humans, such as heart failure, diabetes, obesity, kidney, infectious and malign diseases, and genetic disorders. Much evidence speaks in favor of the significance of miRNA in the development of the kidneys and physiology of the heart. It is thus not surprising that a disorder of miRNA regulation can be observed in many different kidney and heart diseases. The discovery that circulating miRNA can be detected in the serum and plasma and that their expression can vary due to disease represents a significant potential for their use as a new biomarker. Therapy based on miRNA can act by either restoring their function or blocking their expression and activity, making it very promising.

Asja Stipić Marković, Ana Marija Valetić, Ingrid Prkačin

Autoimmune diseases can cause significant and chronic morbidity and disability. Women are at a 2.7 times greater risk than men of acquiring autoimmune diseases. Cardiovascular risk in female patients with systemic lupus erythematosus and rheumatoid arthritis indicates early atherosclerosis. Patients with systemic lupus erythematosus have a 5-8 times higher incidence of coronary artery disease than the general population, which is associated with dyslipidemia, the presence of LDL-phenotype B, and simultaneously present systemic inflammation. Premature atherosclerosis in these patients is the result of traditional cardiovascular risk factors, factors specific to autoimmune disease, and inflammatory mediators. Since cardiovascular diseases are the leading cause of death, this raises the question of preventive cardiology treatment. If kidney failure develops with lupus nephritis and chronic kidney disease, the cardiovascular risk multiplies.