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Obesity with no comorbidities probably carries no cardiovascular risk, and the so-called obesity paradox even comes into play, wherein obesity may improve the prognosis of cardiovascular disease. Cardiovascular complications primarily occur indirectly due to metabolic comorbidities of obesity. However, a thrombogenic potential of obesity has also been established. A very important question in contemporary obesitology is whether antidiabetics currently administered in obese non-diabetic individuals will have a positive cardiovascular effect similar to that in diabetics. Myokines, muscle tissue hormones, certainly have a protective effect on the cardiovascular system. Also of importance is the research into epicardial and pericardial fat. Its investigation and management will aid in finding additional options of diagnosing and treating cardiovascular disease.Cardiovascular disease is still the most common cause of mortality in patients with type 2 diabetes. Some prospective studies have produced unexpected results in connection with the requirements for the demonstration of cardiovascular safety of new antidiabetics, which have significantly expanded the treatment options for diabetes over the past 20 years. Although these studies were statistically designed to exclude excessive cardiovascular risk in patients with type 2 diabetes, some drugs have shown not only cardiovascular safety but also significant cardioprotective and nephroprotective effects in these studies. For the first time, a reduction in cardiovascular and overall mortality was demonstrated for the SGLT2 inhibitor empagliflozin in EMPA-REG OUTCOME trial in patients at very high cardiovascular risk. We already know that a beneficial effect on the risk of heart failure, but also renal failure, is a class effect in gliflozins. The revolutionary benefits of SGLT2 inhibitors are now perceived not only by diabetologists, but also by cardiologists and nephrologists. In European Society of Cardiology clinical guidelines, gliflozins even endanger the still unshakable position of metformin as the first line of antidiabetic therapy in patients with very high cardiovascular risk. Their indication should be today considered in all patients with type 2 diabetes and atherosclerosis, cardiac and renal failure regardless of diabetes control because they can reduce cardiovascular risk, risk of hospitalizations for heart failure and preserve glomerular filtration rate.Cardiovascular complications are main cause of increased mortality in patients with type 2 diabetes. AZD0156 chemical structure Decrease of overall cardiovascular risk and subsequently cardiovascular morbidity and mortality in type 2 diabetes patients is therefore an important treatment aim. To this end, intensive intervention of classical risk factors such as dyslipidemia, arterial hypertension, smoking along with lifestyle intervention is necessary. Good diabetes control optimally with the use of antidiabetic medication and smoking with positive effect on cardiovascular complication is of high importance as well. Incretin-based therapy includes an approach based on an increase of endogenous GLP-1 concentrations by inhibition of its breakdown by dipeptidyl-peptidase 4 (DPP-4 inhibitors or gliptins) or he use of GLP-1 receptor agonists that owing to modified structure have much longer half-life than endogenous GLP-1 and act the use through stimulation of GLP-1 receptor. The aim of this paper is to summarize the use of these two groups of antidiabetic drugs - gliptins and GLP-1 receptor agonists - in patients with type 2 diabetes focusing on the their cardiovascular effects and their influence on cardiovascular complications.PCSK9 inhibitors (inhibitors of proprotein convertase subtilisin/kexin type 9) offer a promising treatment strategy decreasing the concentrations of both atherogenic low density lipoprotein (LDL) and cholesterol contained within LDL. Alirocumab is one of two PCSK9 inhibitors that entered clinical practice so far. Alirocumab is a specific antibody against PCSK9, manufactured using recombinant technique. When the antibody binds to the PCSK9 isoenzyme, no complex encompassing PCSK9 and LDL receptor can be formed, thus enabling further recirculation of the LDL receptor. Increasing the amount of LDL receptors available on the cell membranes leads to higher internalization of LDL within cells and to lowering of LDL cholesterol concentration. It has been shown that alirocumab exerts favorable effect on atherogenic lipoproteins (i.e. decrease of concentrations of LDL cholesterol by more than 50%) both in monotherapy and in combination with statins or other hypolipidemics. Odyssey Outcomes study brought new information into light and changed the guidelines of treating the patients with cardivascular diseases. Alirokumab added to intensive statin therapy reduced significantly the risk of cardiovascular diseases and the post hoc analysis confirmed also the reduction of total death rate. The positive effect of alirocumab is higher in patients with higher initial LDL-C. The therapy with alirokumab is safe, with minimum adverse events.In June 2018, 77-year-old man was referred to The Department of Haematooncology, University Hospital Ostrava, for suspicion of multiple myeloma. This was supported by laboratory findings of hypercalcemia, paraprotein IgA κ in serum and by the presence of multiple osteolytic skeletal lesions. Low number of plasma cells in bone marrow sample - cytologically (3.6 %) as well as in flow cytometry (less than 95 % clonal plasma cells out of total bone marrow plasma cells) - pointed at the direction of monoclonal gammopathy of undetermined significance (MGUS). In the course of differential diagnosis of hypercalcemia, elevated level of parathormone had been found which led to the performance of 99mTc-MIBI scintigraphy where parathyroid adenoma was discovered and later histologically verified. The final diagnosis was determined as a coincidence of MGUS and primary hyperparathyroidism. This case report also contains brief differential diagnosis of hypercalcemia and osteolytic skeletal lesions and suggestions for their diagnostic algorithms.
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