Search

The emerging field of cardio-oncology addresses the critical need for specialized cardiovascular care in cancer patients, given the overlapping risk factors and potential cardiovascular complications of oncological therapies. In collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO), and the European Society of Cardiology (ESC), the first cardio-oncology guideline was developed and published in 2022. This guideline comprises 272 recommendations covering risk stratification before therapy initiation, monitoring during oncological treatment, and the diagnosis and treatment of therapy-associated cardiovascular side effects.A significant innovation in this guideline is the comprehensive risk stratification approach, which categorizes patients into low, moderate, and high-risk groups based on therapy-specific factors. This allows for tailored cardiovascular care during therapy, with varying frequencies of follow-up examinations depending on the patient's risk level. Notably, the guideline emphasizes the importance of interdisciplinary collaboration between oncologists and cardiologists to optimize patient outcomes.Overall, the cardio-oncology guideline represents a significant advancement in addressing the complex cardiovascular needs of cancer patients. Its comprehensive recommendations and emphasis on interdisciplinary care underscore the importance of optimizing cardiovascular health throughout the oncological treatment journey.This review provides an overview of the guidelines and updates on the risk stratification and therapy of patients with immune checkpoint inhibitor-associated myocarditis (ICIM), as well as the role of statins in protecting against anthracycline-associated cardiotoxicity., Competing Interests: LHL hat Daiichi Sankyio, Senaca, Astra Zeneca und Servier beraten und erhielt Honorare von Novartis, Astra Zeneca und MSD, (Thieme. All rights reserved.)

Air pollution and traffic noise are two important environmental risk factors that endanger health in urban societies and often act together as "partners in crime". Although air pollution and noise often co-occur in urban environments, they have typically been studied separately, with numerous studies documenting consistent effects of individual exposure on blood pressure. In the following review article, we examine the epidemiology of air pollution and noise, especially regarding the cardiovascular risk factor arterial hypertension and the underlying pathophysiology. Both environmental stressors have been shown to lead to endothelial dysfunction, oxidative stress, pronounced vascular inflammation, disruption of circadian rhythms and activation of the autonomic nervous system, all of which promote the development of hypertension and cardiovascular diseases. From a societal and political perspective, there is an urgent need to point out the potential dangers of air pollution and traffic noise in the American Heart Association (AHA)/American College of Cardiology (ACC) prevention guidelines and the European Society of Cardiology (ESC) guidelines on prevention. Therefore, an essential goal for the future is to raise awareness of environmental risk factors as important and, in particular, preventable risk factors for cardiovascular diseases., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

The assessment of individual cardiovascular disease risk (CVD) is essential for a cost-effective prevention of cardiovascular morbidity and mortality. While almost half of the population have a very low CVD risk approximately 1/5 th of the population have a CVD risk >20% over the next 10 years.Modern risk scores like the ESC-SCORE2 help to identify those in need of intensified preventive efforts based on basic risk factors like smoking, systolic blood pressure, total cholesterol, age, and sex. According to current ESC-guidelines all men >45 years and all women >55 years should be assessed with SCORE2, which is the best calibrated and validated scoring system for Europe.The calculation of total cardiovascular risk also permits to calculate an individual heart-age, which makes it easier for the individual patient to understand his own risk profile. Most current risk estimation systems can be accessed online under u-prevent.com/calculators., Competing Interests: SG gibt folgende Vortragshonorare an: Boehringer Ingelheim, Daiichi Sankyo, Cardinal Health, AMGEN, Bayer, AstraZeneca, Abbott; Advisory Board Membership: Bayer AG, Boehringer Ingelheim, Abbott, Siemens Healthineers., (Thieme. All rights reserved.)

Elevated triglycerides and their lipidological consequences (small, dense LDL, residual particles (remnants), reduced HDL cholesterol) are an important and independent cardiovascular risk factor. Particularly in diabetes mellitus, hypertriglyceridemia is regarded as the main cause of high cardiovascular morbidity and mortality; very high triglyceride levels can cause acute pancreatitis. This article provides an overview of the current scientific status of the pathogenesis and clinical significance of hypertriglyceridemia., Competing Interests: Merkel: Honorare für Vorträge und Beratungen von Sanofi, Amgen, Lilly, MSD, Berlin-Chemie, Böhringer, Astra, Novartis, Akcea, Biomarin, Daiichi-Sankyo, Gilead, Pfizer, Novo, SOBI.Parhofer: Honorare für Vorträge, Advisory-Board-Tätigkeit, für DMC-Tätigkeit und/oder Forschungsunterstützung von folgenden Unternehmen: Akcea, Amarin, Amgen, Boehringer Ingelheim, Dr. Schär, Daiichi-Sankyo, MSD, Novartis, Regeneron, Sanofi, Silence Therapeutics und SOBI.Müller-Wieland: Honorare für Vorträge und Beratungen von Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Daiichi-Sankyo, Lilly, MSD, Novartis, Novo Nordisk, Sanofi, Sanofi-Pasteur.Laufs: Honorare für Vorträge oder Beratungen von Amarin, Amgen, Daiichi-Sankyo, Novartis, Sanofi., (Thieme. All rights reserved.)

CARDIOVASCULAR RISK PROFILE OF PATIENTS WITH INFLAMMATORY ARTHRITIS:  Patients with inflammatory arthritis have an increased risk of cardiovascular disease compared to the general population. The discovery of this fact dates back to over a decade ago, but cardiovascular morbidity and mortality in these patients have not yet significantly improved. In 2021, the management of cardiovascular risk in patients with inflammatory arthritis remains an important aspect for general practitioners, rheumatologists and researchers. CARDIOVASCULAR RISK ASSESSMENT:  Risk scores used for the general population often underestimate the increased cardiovascular risk in patients with inflammatory arthritis. Inflammation was repeatedly found to be an independent cardiovascular risk factor. However, attempts to incorporate inflammation markers into risk scores has not yielded an improved risk prediction so far. Further studies need to investigate the influence of disease-specific factors like disease activity or treatment effect on cardiovascular risk. Currently, there is no independent risk assessment specifically established for patients with inflammatory arthritis. INFLUENCE OF ANTIRHEUMATIC DRUGS ON CARDIOVASCULAR RISK: Antirheumatic drugs can modify cardiovascular risk. The most pronounced protective effect was found in biologics. Tumor necrosis factor α inhibitors, for instance, reduce cardiovascular event rate by 15 %. Data on methotrexate is less robust but also suggests a protective effect in patients with inflammatory arthritis. Studies on the relatively new janus kinase inhibitors are expected to provide new data in the coming years., Competing Interests: PN: Übernahme der Reise- und Teilnahmekosten an Tagungen durch Eli Lilly, Novartis, Roche und UCB.CB: Honorare für Vortrags- und Beratertätigkeit von Abbvie, BMS, Boehringer, Hexal, Gilead, Janssen, Pfizer, Roche., (Thieme. All rights reserved.)

Chronic kidney disease (CKD) is associated with substantial cardiovascular morbidity and mortality. This is mediated by the high prevalence of traditional cardiovascular risk factors in patients with CKD such as arterial hypertension and diabetes mellitus, but also by the presence of CKD-specific so-called nontraditional cardiovascular risk factors such as vascular calcification, uremic toxins, uremic dyslipidemia as well as inflammation and oxidative stress. Therefore, the primary and secondary prevention of cardiovascular disease represents an integral part of nephrology. This entails optimal control of blood pressure and diabetes, therapy of the uremic dyslipidemia as well as lifestyle-modifying factors such as weight reduction and smoking cessation.

Cardiovascular diseases are among the leading causes of death worldwide. Apart from a few exceptions heart attack, stroke and peripheral arterial occlusive disease first occur in later adulthood. The cornerstone for these diseases, however, is already laid by accelerated vascular aging in childhood. Apart from pediatric medical preventive check-ups, the medical care of the parents should also be a reason for taking action. A detailed family history enables many conclusions to be drawn about the cardiovascular risk of the next generation This requires targeted diagnostics and appropriate interventions in childhood ranging from lifestyle measures up to pharmaceutical therapy. In this context the current guidelines on the diagnostics and treatment of hypercholesterolemia and arterial hypertension in children and adolescents are also presented.

Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht.

During the past 10 years nonalcoholic fatty liver disease (NAFLD) has moved more and more into the focus of attention of clinical research. The term NAFLD comprises the simple nonalcoholic steatosis or fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). As the incidence of NAFLD has dramatically increased, it is expected that during the coming years NASH in particular will become the main reason for liver transplantation in industrialized countries. In addition, it has become evident that scirrhotic liver fibrosis can develop directly from NAFL without going through the stage of NASH. Finally, there is accumulating evidence that both NAFL and NASH are strongly associated with an increased risk of type 2 diabetes and cardiovascular diseases and on the other hand that NAFL and NASH are complications of diabetes. This article addresses the current knowledge about the prevalence, diagnosis, risk prediction and treatment of NAFLD.

The guideline of the European Society of Cardiology recommends an LDL-C target < 70 mg/dL or a 50 % reduction in patients with manifest peripheral arterial disease (PAD) as well as in CHD or cerebrovascular disease when the baseline LDL-C is between 70 and 135 mg/dL. Application of a PCSK9 inhibitor allows target attainment for those patients who do not achieve this under maximal conventional therapy with a statin in combination with ezetemib. In the Fourier study, patients with PAOD who had neither a myocardial infarction nor a stroke at admission of the study had a significant risk reduction (RR) of both cardiovascular (RR = 0.67, 0.47 - 0.96, p = 0.0283) as well as extremity endpoints (RR = 0.43 (0.19 - 0.99; p = 0.042). In Germany these patients are primarily seen by angiologists. This group of vascular specialists is specifically mentioned in the decision of the Federal Joint Committee as one of those who may indicate treatment with PCSK9 inhibitors., Competing Interests: Die Autoren haben im unterschiedlichen Ausmaß an den Zulassungsstudien für PCSK9-Inhibitoren teilgenommen und honorierte Vorträge für die Firmen Amgen und Sanofi gehalten., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: The German Prevention Act, the main parts of which came into force on 25 July 2015, encourages health promotion and prevention programs for people in their living environment. Through this act, preventive measures could reach employees at work that hardly seek medical services. This is of importance since employees with a low occupational position often show risk factors that increase morbidity and mortality., Methods: In this study, clinical data from n = 2280 employees from small and medium sized enterprises (SME) were analyzed for economic sector, sex, socioeconomic position (SEP), economic sector cardiovascular risk factors, musculoskeletal and psychological diseases. The socioeconomic position was categorized using the European Socioeconomic Classification into an intermediate/high and a low SEP category., Results: Male employees showed a significantly higher occurrence of risk factors, such as smoking, diabetes or hypertension in comparison to female employees. In the manufacturing industry, male employees with a low SEP showed a higher prevalence of diabetes (2.3 vs. 5.9%), smoking (27.4 vs. 46.5%), and physical inactivity (sports: 55.0 vs. 37.1%) in comparison to employees with an intermediate/high SEP. Male employees with a low SEP from health and social services reported psychiatric disorders more frequently in comparison to those with an intermediate/high SEP (0.7 vs. 5.9%)., Conclusion: Male employees with a low SEP should be given special consideration in the implementation of preventive measures at work within the framework of the Prevention Act.

Hypertension, diabetes mellitus and dyslipidaemia are among the most important cardiovascular risk factors. In addition, there is an association with the development and progression of glaucoma. During the last years, there has been an intense discussion concerning optimal treatment goals for these risk factors. Recently, the American Heart Association has defined a blood pressure greater than 130/80 mmHg as hypertension and the European guidelines will follow this definition. These lower blood pressure limits increase the risk for a too strict blood pressure treatment with night values, which might be too low for glaucoma patients. In contrast, the treatment goals for LDL cholesterol should be as low as possible ("the lower the better"). There is a more differentiated picture concerning treatment goals for diabetes mellitus. For elderly patients, which is the main group of the glaucoma patients, a less intense blood sugar reduction is currently recommended with an HbA 1c value of above 7%. The present paper summarizes the significance of cardiovascular risk factors and the respective treatment goals for the therapy of patients with glaucoma., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Severe hypertriglyceridemia is defined at a plasma triglyceride (TG) concentration of >885 mg/dl and may result - in particular when clinical symptoms appear before the age of 40 - from "large variant" mutations in genes which influence the function of the lipoprotein lipase (LPL). For diagnosis, secondary factors have to be excluded and treated before further genetic tests are considered. Typical symptoms in almost all patients are recurrent, sometimes severe abdominal pain attacks, which can result in acute pancreatitis, the most important, sometimes life-threatening complication. To minimize the risk of severe pancreatitis, the aim is to maintain the plasma TG concentration <1000 mg/dl. Other clinical manifestations which can occur and are reversible are eruptive xanthomas, lipemia retinalis, hepatosplenomegaly, dyspnea syndrome, and impaired neurocognitive function. The hyperviscosity syndrome caused by chylomicronemia is seen as the underlying reason for some of the symptoms. Patients with mild-to-moderate hypertriglyceridemia have an increased cardiovascular risk. To lower this is the primary treatment goal here. Treatment mainly consists of a life-long, strict fat- and carbohydrate-restricted diet and the abstention from alcohol. Omega‑3-Fatty acids and fibrates can be used to lower plasma TG levels. Recently, new gene therapy approaches for LPL-deficient patients have become available in Germany.

The prevalence of sleep-disordered breathing (SDB) is high in patients with cardiovascular diseases. Typical symptoms like daytime sleepiness can be absent and those patients may report unspecific, therapy-resistant symptoms related to their underlying disease. Particularly sleep-related symptoms like nocturia, nocturnal dyspnea and pectangina can be present. Based on the results of recently published studies, the treatment of central sleep apnea in patients with symptomatic, systolic heart failure by adaptive servo-ventilation is no longer recommended. Although the treatment of obstructive sleep apnea did not prevent cardiovascular events, it improved snoring, daytime sleepiness and health-related quality of life. Furthermore, studies imply that treatment of SDB should be considered as an adjunct treatment modality in patients with hypertension and atrial fibrillation. Due to the high prevalence, screening for SDB can help to identify patients at high cardiovascular risk., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

Gender medicine is concerned with the question of why diseases are expressed differently in the genders. It takes differences between men and women into account, which are often neglected by traditional medicine. Sex differences can also be found in cardiovascular diseases; therefore, risk factors for cardiovascular diseases have a different significance depending on the sex. Diabetic diseases tend to promote the occurrence of coronary heart disease (CHD) more strongly in women than in men. Myocardial infarctions affect women 10 years later than men and young women are often treated too late, possibly because myocardial infarction is consider to be a "male disease". The number of cases of coronary syndrome is significantly increasing, particularly in young women. Some of the diseases which predominantly occur in women are takotsubo cardiomyopathy, microcirculation disorders and spontaneous coronary artery dissection. Pharmacological treatment of CHD is principally the same in men and women but attention must be paid to differences in the pharmacokinetics of important drugs. Coronary dilatation has comparable effects in both men and women but more complications occur in women. Cardiac failure with impaired left ventricular systolic function affects more men than women in the Western world but the opposite is true for cardiac failure with preserved left ventricular ejection fraction. Hypertrophic and dilatative cardiomyopathies are more frequent in men. Many of the drugs used to treat cardiac failure have different actions in men and women. Too little attention is paid to the pharmacokinetics and pharmacodynamics in women when testing active agents; however, awareness of the differences that need to be considered is growing.

Synephrine is a sympathomimetic phenylethylamine derivative that occurs naturally in citrus fruits. It is often added to dietary supplements intended for weight loss and enhancement of sports performance, typically in the form of Citrus aurantium extracts and in many cases in combination with caffeine. The health risks of synephrine were evaluated on the basis of the available toxicological data and in accordance to the EFSA guidance on the safety assessment of botanicals and botanical preparations intended for use in food supplements. In animal studies, orally applied synephrine induced adrenergic effects on the cardiovascular system (increase of blood pressure, ventricular arrhythmias), which were enhanced by the concomitant application of caffeine as well as physical activity. Some human intervention studies investigating the acute effects of synephrine on blood pressure and heart rate of healthy, normotensive test persons indicate that synephrine can induce cardiovascular effects in humans. A series of published case reports of adverse cardiovascular effects (hypertension, cardiac arrhythmia, myocardial infarction) were associated with consumption of synephrine- and caffeine-containing dietary supplements. In conclusion, consumption of high amounts of synephrine, especially in combination with caffeine and physical exercise, is associated with an increased risk of adverse effects on the cardiovascular system. According to the assessment by the BfR (Bundesinstitut für Risikobewertung), daily intake of synephrine through dietary supplements should not exceed the median intake from conventional foods.

The numbers of survivors of cancer have increased as a consequence of advances in chemotherapy; however, the side effects of cancer treatment have become increasingly more important. The most frequent side effects include cardiovascular complications, which can lead to acute and delayed morbidity and mortality, often many years later. The discipline of cardio-oncology deals with the prevention, diagnostics and treatment of cardiovascular diseases caused by cancer therapy. The most important cardiovascular side effects of cytostatic therapy are heart failure due to myocardial dysfunction (cardiotoxicity), coronary artery disease, valvular disease and ventricular arrhythmia as a result of QT extension. In addition, arterial hypertension, thromboembolic events, pulmonary hypertension, vasculopathy and pericardial complications can also occur. Fundamentally, a strict limitation of risk factors is necessary to minimize the cardiovascular side effects of potentially cardiotoxic therapeutic procedures. Patients with impaired left ventricular function should be identified by echocardiographic examination prior to cardiotoxic chemotherapy. Treatment with beta blockers and angiotensin-converting enzyme (ACE) inhibitors can also be indicated in asymptomatic patients in order to minimize the effects of chemotherapy on myocardial dysfunction. Prophylactic administration of ACE inhibitors and beta blockers during anthracycline chemotherapy can be considered in patients free of cardiac disease.

Current evidence suggests that a dysregulated, i.e. systemic and extensive, immune response causes sepsis-induced multiple organ failure. Notably, this does not only imply the initial inflammatory reaction but also the delayed sepsis-associated depression of the immune system. Endothelial dysfunction and sepsis-induced coagulopathy represent additional major pathomechanisms. Based on multiple interactions between mediators und receptors all of these mechanisms can be discussed individually only for didactical purposes. Clinically, there are charateristic microcirculatory disorders and macrocirclatory changes resulting in an impaired oxygen transport capacity. Due to an additional cytopathic hypoxia, organ function might be impaired even if physiological partial pressures of oxygen are restored. Although these changes are often functional and potentially reversible, mortality increases up to 70% in case of multiple organ failure., (© Georg Thieme Verlag KG Stuttgart · New York.)

For decades the administration of oxygen has been a corner stone in the treatment of various medical emergencies, e.g. acute myocardial infarction. Several arguments support the perioperative use of high oxygen concentrations (>80%) for the prevention of surgical site infections. However, effects of oxygen include an increase in systemic vascular resistance, a reduction in heart rate and stroke volume and thus an impairment of the microcirculation, e.g. in the coronary and cerebral vasculature. Adequately powered, prospective, randomized, blinded outcome studies on the effects of hyperoxia in anesthesia and intensive care medicine are scarce. Recent data suggest that hyperoxia may be more harmful than beneficial and may increase morbidity and mortality in surgical and intensive care patients. Also, the current guidelines from the European Resuscitation Council from 2015 address the potentially harmful effects of high oxygen concentrations in various emergency settings. The aim of this article is to give an overview about the physiological and clinical effects of hyperoxia with a focus on its use in perioperative and intensive care medicine., (© Georg Thieme Verlag Stuttgart · New York.)

In patients with hypertension without diabetes and with an increased risk of cardiovascular complications a blood pressure of below 130 mmHg should be targeted. Hypertensive patients with an age above 80 years should be treated in the same way as younger hypertensive patients if they are otherwise healthy and functionally independent. On the other hand frail elderly patients could have an increased morbidity and mortality with intensive blood pressure control. In patients with resistant hypertension spironolactone was the most effective drug when given in addition to their baseline drugs (ACE-inhibitor/angiotensin receptor antagonist, calcium channel blocker and thiazide diuretic)., (© Georg Thieme Verlag KG Stuttgart · New York.)

Ensuring an adequate intake of calcium--by means of supplements, if necessary--is a well-established approach in prevention and therapy of osteoporosis. However, in the meantime concerns have been voiced doubting the safety of calcium supplements. The discussion commenced when a new evaluation of the Auckland calcium intervention study revealed a higher rate of myocardial infarction after administration of calcium, compared to placebo. Two meta-analyses on the cardiovascular risk of calcium supplements supported these findings. Nevertheless, these results are still discussed contentiously. Doubts were increased by the fact that neither a reevaluation of the WHI calcium vitamin D study, nor a current meta-analysis could identify calcium as a cardiovascular risk factor. Against this background the present article analyses the controversial data with respect to the well-known "Hill-criteria" of causality, including consistency of data, magnitude of association, dose-response relationship and biological plausibility.

Arterial hypertension is a widespread risk factor for cardiovascular disease. The benefit of a consistent drug therapy is proportionally associated with the degree of blood pressure reduction. By extrapolating the data, the assumption arose “the lower the better” and was widely accepted. However, several studies found an increase in morbidity and mortality with an excessive reduction of blood pressure (J-curve). This seems to affect mainly cardiac risk, and only at lower blood pressures<60 mmHg also the cerebral risk. An important factor here is the diastolic blood pressure. Others found a linear correlation. Overall, a j-shaped connection remains controversial and is not considered equally for all organ systems. At the same time cardiovascular risk seems not to increase with additional reduction in blood pressure of <140 mm Hg to <120 mmHg. This has led to the latest guidelines of all societies recommending higher target values. Reasons for higher targets in drug therapy of arterial hypertension, are increased adverse drug reactions or increased healthcare costs with few additional benefit. The current recommendations of the ESH/ESC, AHA/ACC/ASH and the JNC 8 set a higher target value for some subgroups, but remain inconsistent among themselves.

To improve the prevention of cardiovascular complications and events in hypertensive patients, it is of major importance to estimate the patient's individual risk for cardiovascular events. Antihypertensive treatment should not only be based on blood pressure values anymore, but also on the patient's comorbidities and risk profile. Risk stratification takes into account cardiovascular risk factors, diabetes, asymptomatic organ damage and established cardiovascular or renal disease. The most important markers for asymptomatic organ damage which should be searched for are microalbuminuria and LVH. Current guidelines emphasize the importance of the adaption and selection of treatment according to asymptomatic and established organ damage and provide assistance for treatment decisions. They focus also on the different non-pharmacological therapy options and lifestyle modifications. The goal of this article is to summarize the most important innovations and to point out the importance of simple tools for the implementation of cardiovascular risk stratification in hypertensive patients.

Arterial hypertension remains the most important risk factor for cardiovascular and renal diseases. In view of an increasing prevalence with older age and an increasingly aging population, the treatment of elderly patients with arterial hypertension will become increasingly important in daily practice. Arterial hypertension in the elderly differs in many aspects from arterial hypertension in younger patients. For example, isolated systolic hypertension is the predominant form of arterial hypertension in the elderly. In comparison to younger patients, treatment of hypertension in the elderly is less well investigated. However, available data suggest that lowering of blood pressure in the elderly and very elderly reduces the risk of heart failure, stroke, and even mortality. The best evidence for the treatment of hypertension in the elderly exists for diuretics and calcium antagonists. However, the primary choice of antihypertensive therapy should be guided by the presence of existing cardiovascular and/or renal comorbidities.

Therapy-resistant hypertension is a frequent finding in clinical practice. It is associated with a significantly increased risk for cardiovascular and renal events. Causes include but are not limited to erroneous blood pressure measurements, compliance issues, blood pressure increasing co-medication, and secondary hypertension. During the last years, several medical and interventional therapeutic approaches have been described and introduced into clinical practice. The goal of this paper is to summarize the clinically relevant diagnostic and therapeutic aspects related to therapy-resistant hypertension and to give an overview on the rational approach to this clinical problem.

The modern life style is often characterized by a lack of physical activity as well as unhealthy diet leading to a worldwide rise in obesity. This goes along with an increased incidence of type 2 diabetes, accompanied by an accelerated atherosclerosis. Life style changes and normalization of body weight therefore represent the cornerstones of diabetes prevention. In addition, a multi-factorial approach focusing on cardiovascular risk factors like dyslipidemia, hypertension and hyperglycemia enables an effective means for the prevention of micro- or macrovascular complications., (© Georg Thieme Verlag KG Stuttgart · New York.)

The rate of treatment and control increased significantly in Germany during the last years. Severeal studies could demonstrate an association of sodium consumption with blood pressure. The status of renal denervation in the treatment of high blood pressure remains unclear., (© Georg Thieme Verlag KG Stuttgart · New York.)