Prof. dr hab. Grażyna Odrowąż-Sypniewska – Vice-Rector for Collegium Medicum, and prof. dr hab. Jacek Kubica – Vice-Rector for Research, are involved in research studies contributing to the development of new clinical guidelines published in high-ranking journals.
We are pleased to say that two of our vice-rectors: prof. dr hab. Grażyna Odrowąż-Sypniewska – Vice-Rector for Collegium Medicum, and prof. dr hab. Jacek Kubica – Vice-Rector for Research, are involved in research studies contributing to the development of new clinical guidelines and recommendations published in high-ranking journals.
Prof. dr hab. Grażyna Odrowąż-Sypniewska, Vice-Rector for Collegium Medicum, is a member of the joint EAS-EFLM international panel of experts (European Atherosclerosis Society – EAS and European Federation of Clinical Chemistry and Laboratory Medicine – EFLM), which has recently developed new guidelines for the determination of lipid profiles for the purposes of cardiovascular risk assessment, introducing an alternative method which does not involve fasting before lipid profile testing.
The guidelines were published in two high-ranking journals: the European Heart Journal and Clinical Chemistry under the title: “Fasting Is Not Routinely Required for Determination of a Lipid Profile: Clinical and Laboratory Implications Including Flagging at Desirable Concentration Cutpoints-A Joint Consensus Statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine” (Nordestgaard BG, Langsted A, Mora S, Kolovou G, Baum H, Bruckert E, Watts GF, Sypniewska G, Wiklund O, Borén J, Chapman MJ, Cobbaert C, Descamps OS, von Eckardstein A, Kamstrup PR, Pulkki K, Kronenberg F, Remaley AT, Rifai N, Ros E, Langlois M; European Atherosclerosis Society (EAS) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Joint Consensus Initiative).
Early identification of lipid metabolism disorders is an essential element of the primary prevention of cardiovascular diseases. In accordance with current guidelines of the European Society of Cardiology and the European Atherosclerosis Society (ESC/EAS), performing a lipid profile analysis should be considered in men over 40 and women over 50 years of age. Lipid profile assays should also be performed in children aged 9-11. It is commonly acknowledged that lipid profile tests are best performed after 8-10 hours of fasting. However, EAS/EFLM guidelines from 2016 indicate an alternative testing possibilities in non-fasting patients. Recent studies reveal that differences in the levels of total, LDL and HDL cholesterol measured after fasting and non-fasting periods are not significant. Four population studies – Copenhagen General Population Study (Denmark, Langsted et al. 2008, Langsted, Nordestgaard 2011), Women’s Health Study (USA, Mora et al. 2008), National Health and Nutrition Examination Survey (USA, Steiner et al. 2011) and Calgary Laboratory Services (Canada, Sidhu, Naugler, 2012) – demonstrated a clinically insignificant increase in the concentration of triglycerides in non-fasting patients and an insignificant decrease in the levels of total and LDL-C cholesterol (caused by haemodilution); no differences were found in HDL-C levels. Research studies carried out so far point to alternative methods of lipid profile assessment which do not involve fasting – a requirement particularly burdensome for older adults, children and chronically ill patients.
The most recent guidelines developed by the Canadian Cardiovascular Society and related to the management of hypertensive patients also include the alternative determination of lipid profile without prior fasting (Leung et al. 2016. Hypertension Canada’s 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension. Can J Cardiol; 32:569-588). The team of EAS/EFLM experts has already developed further guidelines: “Measuring atherogenic lipoproteins: current and future challenges in the era of personalized laboratory medicine” will be published soon.
The 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation were developed by a specially appointed Task Force of the European Society of Cardiology (ESC). The recommendations are based on the results of numerous research studies carried out worldwide, including three projects conducted in Poland. One of them is the randomised, placebo-controlled IMPRESSION trial analysing the impact of morphine on the pharmacokinetics and pharmacodynamics of ticagrelor in post-infarction patients, conducted at the Department of Cardiology and Internal Diseases of the Faculty of Medicine at NCU Collegium Medicum and headed by prof. dr hab. Jacek Kubica.
Results of the world’s first randomised clinical trial which demonstrated the negative effect of morphine on ticagrelor exposure and on its antithrombotic activity in patients with acute myocardial infarction – one the leading causes of death in industrialised countries – were presented in the publication: „Morphine delays and attenuates ticagrelor exposure and action in patients with myocardial infarction: the randomized, double-blind, placebo-controlled IMPRESSION trial”. The paper was published in the European Heart Journal (Impact Factor 20.213), one of the world-leading cardiology journals published by the European Society of Cardiology, and its findings were included in the new ESC Guidelines.