natgillin/translations-raw huggingface dataset:
ESC/EAS guidelines are recommendations made by various societies in consultation with task forces, expert groups or consensus panels, with the aim of assisting physicians in selecting the best management strategies for an individual patient with a given condition taking into account the impact on outcome as well as the risk/benefit ratio of particular diagnostic or therapeutic means.
Smjernice Europskog kardiološkog društva i Europskog društva za aterosklerozu (ESC/EAS) preporuke su različitih stručnih udruženja izrađene u konzultaciji s radnim skupinama, skupinama stručnjaka ili panela za postizanje konsenzusa, s namjerom da se liječnicima pomogne u izboru najboljih strategija liječenja svakog pojedinog bolesnika s tom bolešću, vodeći računa o utjecaju na ishod kao i o omjeru koristi i rizika određenih dijagnostičkih ili terapijskih načina.
Omega-3 acid ethyl esters are an ethyl esters of long-chain polyunsaturated fatty acids with an eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) content of no less than 85% and an EPA to DHA ratio of 0.9 to 1.5.
Etilni esteri omega-3 kiselina etilni su esteri dugolančanih polinezasićenih masnih kiselina koji sadrže eikosapentaenoatnu kiselinu (EPA) i dokosaheksaenoatnu kiselinu (DHA) u količini ne manjoj od 85 % s omjerom kiselina EPA i DHA od 0,9 do 1,5.
Acute coronary syndrome (ACS) associated with typical coronary artery disease (atherosclerosis) is the most common cause of a MI.
Akutni koronarni sindrom, povezan s tipičnom bolešću koronarnih arterija (ateroskleroza), najčešći je uzrok infarkta miokarda.
The patient representative considered there was value to having these products available and not to discourage this aspect of patients' choice given the long history of the use of fish oils in adjunctive medicine and as dietary supplements particularly as there was no evidence of harm with omega-3 supplementation.
Mišljenje predstavnika bolesnika bilo je da te lijekove vrijedi imati na raspolaganju, i da ne treba obeshrabriti taj aspekt bolesnikova izbora uzimajući u obzir dugu povijest ribljeg ulja kao pomoćnog lijeka i dodatka prehrani, a osobito zato što nema dokaza da je dodavanje omega-3 škodljivo.
All these studies carry the risk of a selection bias, which is supported by baseline data provided, e.g. in the retrospective cohort study by Polle (2013)7 only 1 % of post MI patients who were screened were included in the analysis.
Sva ova ispitivanja nose rizik od pristranog izbora ispitanika, što podupiru i osnovni podatci iz npr. retrospektivnog kohortnog Polleovog ispitivanja (2013.)7 u kojem je od bolesnika na probiru, u analizu bio uključen samo 1 % bolesnika nakon infarkta miokarda.
Arch Intern Med. 2012 May 12;172(9):686-694
2012 May 12;172(9):686-694
3 Kwak et al. Efficacy of omega-3 fatty acid supplements (eicosapentaenoic acid and decosahexaenoic acid) in the secondary prevention of cardiovascular disease: a meta-analysis of randomized, double-blind, placebo-controlled trials.
Efficacy of omega-3 fatty acid supplements (eicosapentaenoic acid and decosahexaenoic acid) in the secondary prevention of cardiovascular disease: a meta-analysis of randomized, double-blind, placebo-controlled trials.
The statistical analysis and interpretation were not robust according to current standards.
Prema sadašnjim standardima, statistička analiza i tumačenje rezultata nisu bili robusni.
Moreover, the population included in the REDUCE-IT trial is not comparable with the population of the GISSI-P trial and the indication under review (patients with history of MI), since in addition to established cardiovascular disease or diabetes and other risk factors, patients in the REDUCE-IT trial suffered also from hypertriglyceridemia (> 60% of the patients had TG levels ≥ 200 mg/dL)
Osim toga, populacija uključena u ispitivanje REDUCE-IT nije usporediva s populacijom iz ispitivanja GISSI-P i indikacijom koja se razmatra (bolesnici s infarktom miokarda u povijesti bolesti) jer su bolesnici u ispitivanju REDUCE-IT, osim ustanovljene kardiovaskularne bolesti ili dijabetesa i drugih čimbenika rizika, imali i hipertrigliceridemiju (> 60% bolesnika imalo je razine triglicerida ≥ 200 mg/dl).
In this regard, the results of the GISSI-P trial are not in line with the current standard of care and therefore with the approved indication of Omacor “in addition to other standard therapy (e.g. statins, antiplatelet medicinal products, beta-blockers, ACE inhibitors”.
U tom smislu, rezultati ispitivanja GISSI-P nisu u skladu sa sada važećom standardnom skrbi, a time ni s odobrenom indikacijom za Omacor „osim druge standardne terapije (npr. statini, antitrombotici, beta-blokatori, ACE inhibitori)”.
In addition, it may be questioned if the results are relevant in the context of current MI standard of care which has substantially evolved since the time the study was performed and secondary prevention of CVD.
Nadalje, postavlja se pitanje jesu li rezultati relevantni u kontekstu sada važeće standardne skrbi infarkta miokarda koja se značajno razvila od vremena provedbe ispitivanja i sekundarne prevencije kardiovaskularne bolesti.
Moreover, the American Heart Association states that use of omega-3 fatty acid supplements is ‘reasonable' for patients with prevalent coronary heart disease such as MI, indication that strength of recommendation is therefore low (Class IIa/IIb Recommendation).
Nadalje, Američko udruženje za bolesti srca navodi da je uzimanje dodataka prehrani s omega-3 masnim kiselinama „opravdano” u bolesnika u kojih prevladava koronarna bolest srca kao što je infarkt miokarda, što ukazuje na to da je snaga preporuke mala (preporuka klase IIa/IIb).
The OMEGA study included close to 2000 patients in both arms and over 300 MACE events were reported, more in the omega-3 group than in the placebo group OR 1.25 (0.96-1.52).
Ispitivanje OMEGA uključivalo je gotovo 2 000 bolesnika u obje skupine i zabilježeno je više od 300 MACE događaja, s tim da je broj slučajeva u skupini koja je primala omega-3 bio veći nego u onoj koja je primala placebo, omjer rizika 1,25 (0,96 − 1,52).
Additionally, the level of evidence in these post-hoc subgroup analyses is not strong.
Osim toga, te post hoc analize podskupina nisu pokazale snažnu razinu dokaza.
As the European guidelines do not recommend omega-3 fatty acid medicinal products, they apparently consider the level of evidence and the strength of the recommendation of omega-3 fatty acids in prevention of cardiovascular events both in patients after MI and in patients with other CV conditions rather weak.
Budući da europske smjernice ne preporučuju lijekove koji sadrže omega-3 masne kiseline, očigledno smatraju da su razina dokaza i snaga preporuke za primjenu omega-3 masnih kiselina u prevenciji kardiovaskularnih događaja u bolesnika nakon infarkta miokarda kao i u bolesnika s drugim kardiovaskularnim bolestima, prilično slabe.
Even though the incidence of sudden death may have been too low to draw firm conclusions, the OR for MACE and total mortality was above 1.21 and 1.25 respectively with lower CI close to 1 not supporting an effect in the approved indication.
Iako je incidencija iznenadne smrti možda bila preniska da bi se došlo do čvrstih zaključaka, omjer rizika za MACE i ukupna smrtnost bila je iznad 1,21 odnosno 1,25 s nižim intervalom pouzdanosti blizu 1, koji ne podupire učinak za odobrenu indikaciju.
However CHMP still considered that the results of the GISSI-P trial are inconclusive, since the study has several limitations.
Međutim, CHMP je ipak smatrao da rezultati ispitivanja GISSI-P nisu omogućili donošenje zaključaka jer ispitivanje ima nekoliko ograničenja.
Even though doses and populations in these studies do not fully represent the approved secondary prevention indication, all studies include patients with cardiovascular disease and therefore, these studies are relevant in the context of omega-3 in secondary prevention after MI.
Iako doze i populacije u ovim ispitivanjima ne opisuju u potpunosti odobrenu indikaciju sekundarne prevencije, sva ispitivanja uključuju bolesnike s kardiovaskularnim bolestima; stoga su ova ispitivanja relevantna u kontekstu primjene omega-3 za sekundarnu prevenciju nakon infarkta miokarda.
The increase in bleeding time may be relevant for patients post MI most of which are on single or dual antiplatelet therapy and/or on anticoagulants post MI or for associated diseases.
Produljeno vrijeme krvarenja može biti relevantno za bolesnike nakon infarkta miokarda, od kojih većina prima jednostruku ili dvojnu terapiju antitromboticima i/ili antikoagulansima nakon infarkta miokarda ili za srodne bolesti.
Considering that the high-risk groups of patients with type 2 diabetes, patients with no acute PCI after MI, and patients with impaired systolic function (EF < 50%) have been identified based on post-hoc subgroup analyses conducted on GISSI-P and that these specific groups are not treated according to the current standard of care, the results of these subgroups are not representative and therefore do not support the proposed indication.
Uzevši u obzir da su na temelju post hoc analiza podskupina provedenih za ispitivanje GISSI-P ustanovljene visokorizične skupine bolesnika s dijabetesom tipa 2, bolesnici kojima nije bila provedena akutna koronarna intervencija nakon infarkta miokarda i bolesnici s oštećenom sistoličkom funkcijom (EF < 50 %), i da te specifične skupine nisu liječene prema sada važećoj standardnoj skrbi, rezultati za te podskupine nisu reprezentativni i stoga ne mogu potkrijepiti predloženu indikaciju.
As discussed above, in the last PSUSA for omega-3-acid-ethyl esters, “increase in bleeding time in patients with haemorragic diathesis or receiving treatment with anticoagulants” and “increase in hepatic enzymes that require monitoring in hepatic patients” was included as identified risks.
Prema gore navedenom, u posljednjem postupku PSUSA za etilne estere omega-3 kiselina, kao prepoznati rizici uključeni su „produljenje vremena krvarenja u bolesnika s hemoragijskom dijatezom ili tijekom liječenja antikoagulansima” i „povišenje jetrenih enzima koje zahtijeva praćenje bolesnika s bolestima jetre”.
The opinion of the Group was split: most experts believed that the level of evidence from GISSI-P together with the results from OMEGA is not supportive for using these products in secondary prevention after MI in addition to current standard of care.
Mišljenje Skupine bilo je podijeljeno: većina stručnjaka smatrala je da razina dokaza iz ispitivanja GISSI-P zajedno s rezultatima ispitivanja OMEGA, ne podupiru primjenu ovih lijekova u sekundarnoj prevenciji nakon infarkta miokarda uz sadašnju standardnu skrb.
As stated above, RCT data are available which included sufficient number of patients and resulted in estimates of treatment effect with sufficient precision.
Kao što je prethodno navedeno, dostupni su podatci randomiziranih kliničkih ispitivanja u koja je bio uključen dovoljno veliki broj bolesnika, a dobivene procjene učinka liječenja zadovoljavajuće su preciznosti.
• The Committee for Medicinal Products for Human Use (CHMP) considered the procedure under Article 31 of Directive 2001/83/EC for Omega-3 acid ethyl esters - containing medicinal products for oral in use in secondary prevention after myocardial infarction.
• Odbor za lijekove za humanu uporabu (CHMP) razmotrio je postupak u skladu s člankom 31. Direktive 2001/83/EZ za lijekove koji sadrže etilne estere omega-3 kiselina za peroralnu primjenu u sekundarnoj prevenciji nakon infarkta miokarda.
In conclusion, the totality of data does not support the efficacy of omega-3 fatty acids in prevention after myocardial infarction, including in high-risk patients.
Kao zaključak, ukupni podatci ne podupiru djelotvornost omega-3 masnih kiselina u prevenciji nakon infarkta miokarda, uključujući visokorizične bolesnike.
Studies investigating the effect of omega-3 acid ethyl esters medicinal products on atrial and ventricular arrhythmias did not demonstrate a clinically relevant antiarrhythmic efficacy.
Ispitivanja koja su istraživala učinak lijekova koji sadrže etilne estere omega-3 kiselina na atrijske i ventrikularne aritmije nisu pokazala klinički relevantnu djelotvornost protiv aritmija.
The OMEGA trial was conducted in patients with the approved indication, i.e. MI and used the approved dose of Omacor (1 g/day).
Ispitivanje OMEGA provedeno je u bolesnika s odobrenom indikacijom, tj. infarkt miokarda i uz primjenu odobrene doze lijeka Omacor (1 g dnevno).
With respect to the GISSI-P trial, no new issues have been identified, with the exception of the statement of the MAHs that post-hoc analyses conducted on GISSI-P demonstrated that concomitant treatment with anti-platelet agents, beta-blockers, ACE inhibitors and statins did not alter the therapeutic benefit of Omacor.
U pogledu ispitivanja GISSI-P, nisu ustanovljena nova sporna pitanja, osim tvrdnje nositelja odobrenja da su post hoc analize provedene za ispitivanje GISSI-P pokazale da istodobno liječenje antitromboticima, beta-blokatorima, ACE inhibitorima i statinima nije promijenilo terapijsku dobrobit lijeka Omacor.
The registration of Omacor was based on the GISSI-P study, however, the results of the GISSI-P trial are considered rather weak, since the study has methodological limitations.
Registracija lijeka Omecor temeljila se na ispitivanju GISSI-P, međutim, rezultati tog ispitivanja smatraju se prilično slabe snage dokaza zbog metodoloških ograničenja ispitivanja.
Studies included in the different meta-analysis are heterogeneous with respect to study population (e.g. patients with or without history of cardiovascular disease), study design (open-label or double-blind), source of omega-3 fatty acid intake (dietary or medication intervention), dose and composition of omega-3 fatty acid.
Ispitivanja za koja su provedene različite metaanalize heterogena su s obzirom na ispitivanu populaciju (npr. bolesnici s kardiovaskularnom bolesti u povijesti bolesti ili bez nje), nacrt ispitivanja (otvoreno ili dvostruko slijepo), izvor unosa omega-3 masne kiseline (prehrana ili lijek), doza i sastav omega-3 masne kiseline.
For this, RCT data are available which included sufficient number of patients and resulted in estimates of treatment effect with sufficient precision.
U tom smislu, dostupni su podatci randomiziranih kliničkih ispitivanja u koja je bio uključen dovoljno veliki broj bolesnika, a dobivene procjene učinka liječenja zadovoljavajuće su preciznosti.
The OMEGA study has several strengths compared to the GISSI-P study, e.g. administration of study drug within few days of a MI, a placebo-controlled double-blind design, optimal baseline therapy and endpoints investigated.
Ispitivanje OMEGA ima nekoliko jakih strana u usporedbi s ispitivanjem GISSI-P, npr. primjena ispitivanog lijeka u roku od nekoliko dana od infarkta miokarda, nacrt dvostruko slijepog ispitivanja kontroliranog placebom, optimalna osnovna terapija i ispitivane mjere ishoda.
However, although the retrospective cohort studies seem to confirm the results of the GISSI-P study, they should be interpreted with caution given the known limitations of retrospective cohort studies.
Međutim, iako se čini da retrospektivna kohortna ispitivanja potvrđuju rezultate ispitivanja GISSI-P, s obzirom na poznata ograničenja takvih ispitivanja rezultate treba tumačiti s oprezom.
Medicinal products containing omega-3 acid ethyl esters have been approved in the majority of the European Union Member States for secondary prevention after myocardial infarction (MI) and in the treatment of hypertriglyceridaemia.
Lijekovi koji sadrže etilne estere omega-3 kiselina odobreni su u većini država članica Europske unije za sekundarnu prevenciju nakon infarkta miokarda (IM) te u liječenju hipertrigliceridemije.
In this study, there was a relative risk reduction for one of the two primary MACE endpoint (death, non-fatal MI and non-fatal stroke) of 10% with a rather poor precision (upper CI 0.99), whereas for the other primary endpoint including cardiovascular (CV), instead of all-cause death, statistical significance was not achieved.
U tom je ispitivanju zabilježeno smanjenje relativnog rizika od 10 % u jednoj od dvije mjere primarnog ishoda velikog kardiovaskularnog štetnog događaja (MACE) (smrt, infarkt miokarda bez smrtnog ishoda i moždani udar bez smrtnog ishoda) uz prilično slabu preciznost (gornja granica intervala pouzdanosti od 0,99), dok za ostale mjere primarnog ishoda, uključujući kardiovaskularnu smrt umjesto one bilo kojeg uzroka, statistička značajnost nije dostignuta.
The current approval of omega-3 acid ethyl esters containing products in secondary prevention after myocardial infarction is based on the results of the GISSI-P study performed in 1999.
Sadašnje odobrenje za primjenu lijekova koji sadrže etilne estere omega-3 kiselina u sekundarnoj prevenciji nakon infarkta miokarda temelji se na rezultatima ispitivanja GISSI-P provedenog 1999. godine.
• Even though the meta-analyses by Aung et al. and the recent Cochrane review includes trials with products, doses and populations not exactly representing the approved secondary prevention indication, all studies include patients with cardiovascular disease and therefore, the results are considered as supportive of lack of efficacy.
• Iako metaanaliza koju su proveli Aung et al. i noviji pregled Cochraneove baze podataka uključuju ispitivanja s lijekovima, dozama i populacijama koji nisu točno reprezentativni za odobrenu indikaciju sekundarne prevencije, sva ispitivanja uključuju bolesnike s kardiovaskularnom bolešću i stoga se smatra da rezultati podržavaju nedostatak djelotvornosti.
In this study, there was a relative risk reduction for one of the two the co-primary MACE endpoints of 10% with a rather poor precision (upper CI 0.99) with the second co-primary endpoint just failing to show a significant result.
U ovom je ispitivanju zabilježeno relativno smanjenje rizika u jednoj od dvije mjere koprimarnog ishoda MACE od 10 % s prilično slabom preciznošću (gornja granica intervala pouzdanosti 0,99), dok druga mjera koprimarnog ishoda nije uspjela pokazati značajan rezultat.
Upon request from the CHMP, a SAG CVS meeting was convened on 10 October 2018.
Na zahtjev CHMP-a, 10. listopada 2018. održan je sastanak Znanstvene savjetodavne skupine za kardiovaskularna pitanja (SAG CVS).
Therefore, at the most about 1/3 of the 11,324 randomized patients received appropriate baseline medication at any time during the first year and not more than 5% over the entire first year.
nekom trenutku tijekom prve godine najviše oko 1/3 bolesnika i ne više od 5 % bolesnika tijekom cijele prve godine.
The Swedish national competent authority considered that in light of recent clinical trials, the clinical benefit of omega-3 acid ethyl esters containing products in prevention after MI should be re-evaluated.
Švedsko nadležno nacionalno tijelo smatralo je da je u svjetlu novijih kliničkih ispitivanja potrebno ponovno procijeniti kliničku korist lijekova koji sadrže etilne estere omega-3 kiselina za prevenciju nakon infarkta miokarda.
Upon request from the MAHs, a second SAG CVS meeting was convened on 19 March 2019.
Na zahtjev nositelja odobrenja za stavljanje u promet dogovoren je drugi sastanak Znanstvene savjetodavne skupine za kardiovaskularna pitanja (SAG CVS) 19. ožujka 2019.
ASCEND: A Study of Cardiovascular Events iN Diabetes: Characteristics of a randomized trial of aspirin and of omega-3 fatty acid supplementation in 15,480 people with diabetes.
ASCEND: A Study of Cardiovascular Events iN Diabetes: Characteristics of a randomized trial of aspirin and of omega-3 fatty acid supplementation in 15,480 people with diabetes. https://doi.org/10.1016/j.ahj.2017.12.006.
Based on the above, the CHMP reiterates that RCTs conducted in other CV risk populations are relevant in support of the efficacy (GISSI-HF although borderline and inconclusive) or lack of efficacy (ORIGIN and SU.FOL.OM3) of omega-3 fatty acids in secondary prevention of cardiovascular disease.
Na temelju navedenog, CHMP ponavlja da su randomizirana klinička ispitivanja provedena u populacijama s drugim kardiovaskularnim rizikom, važna kao potvrda djelotvornosti (ispitivanje GISS-HF, iako granično i ne omogućuje donošenje zaključaka) ili nedostatka djelotvornosti (ispitivanja ORIGIN i SU.FOL.OM3) omega-3 kiselina za sekundarnu prevenciju kardiovaskularne bolesti.
These were not rich enough to allow for a full adjustment of differences in risk profiles or to mirror real life post MI situations (e.g. no data regarding smoking history, BMI/obesity, physical exercise were reported in the Macchia study).
Za ove retrospektivne analize bio je dostupan samo ograničeni broj parametara, a oni nisu bili dovoljno izdašni da bi omogućili potpuno usklađivanje razlika u profilima rizika ili odrazili stvarni život u situacijama nakon infarkta miokarda (npr. podatci o povijesti pušenja, indeksu tjelesne mase / pretilosti, tjelesnoj aktivnosti nisu zabilježeni u Macchiaovom ispitivanju).
Therefore if omega-3 fatty acids are effective in reducing cardiovascular events after an MI, cardiovascular benefits in other CV risk populations (e.g. coronary revascularisation, angina pectoris, ischaemic stroke) can be anticipated.
Stoga se, ako omega-3 masne kiseline učinkovito smanjuju kardiovaskularne događaje nakon infarkta miokarda, korisni kardiovaskularni učinci mogu očekivati i u populacijama s drugim kardiovaskularnim rizikom (npr. koronarna revaskularizacija, angina pektoris, ishemijski moždani udar).
• The CHMP considered the totality of the data submitted for omega-3 acid ethyl esters medicinal products with regard to their use in secondary prevention after myocardial infarction.
• CHMP je razmotrio sve podatke dostavljene za lijekove koji sadrže etilne estere omega-3 kiselina u pogledu njihove primjene u sekundarnoj prevenciji nakon infarkta miokarda.
The efficacy of omega-3 fatty acids in the claimed indication has also not been demonstrated by other relevant RCTs conducted in other CV risk populations (e.g. coronary revascularisation, angina pectoris, ischaemic stroke ), including ORIGIN, SU.FOL.OM3, ASCEND, and VITAL.
Djelotvornost omega-3 masnih kiselina u spornoj indikaciji nisu dokazala ni druga relevantna randomizirana kontrolirana ispitivanja provedena u populacijama s drugim kardiovaskularnim rizikom (npr. koronarna revaskularizacija, angina pektoris, ishemijski moždani udar), uključujući ispitivanja ORIGIN, SU.FOL.OM3, ASCEND i VITAL.
Although CHMP considers that the GISSI-P and the OMEGA trials are the most relevant for evaluating the effect of omega-3 containing products in the secondary prevention after MI, it is also acknowledged that RCTs (GISSI-HF, ORIGIN, SU.FOL.OM3) conducted in other CV risk populations (e.g. coronary revascularisation, angina pectoris, ischaemic stroke) are as well relevant, as CV disease is still considered a continuum.
Iako CHMP smatra da su ispitivanja GISSI-P i OMEGA najvažnija za procjenu učinka lijekova koji sadrže omega-3 za sekundarnu prevenciju nakon infarkta miokarda, također je potvrđeno da su važna i randomizirana klinička ispitivanja (GISSI-HF, ORIGIN, SU.FOL.OM3) provedena u populacijama s drugim kardiovaskularnim rizikom (npr. koronarna revaskularizacija, angina pektoris, ishemijski moždani udar) jer se kardiovaskularna bolest i dalje smatra kontinuumom.
Despite the lack of statistical power for the specific “sudden cardiac death” endpoint, the lack of substantial benefit can be concluded from this trial in a statistically valid way, as evidenced by the narrow confidence intervals.
Iako specifična mjera ishoda „iznenadna srčana smrt” nije imala statističku snagu, iz ovog se ispitivanja na statistički valjani način može zaključiti o nedostatku stvarne dobrobiti, kao što to dokazuju uski intervali pouzdanosti.
In view of all the available data, the CHMP considered that the evidence that supported the authorisation of omega-3 in secondary prevention after MI suffered from some methodological limitations and was weak.
S obzirom na sve dostupne podatke, CHMP je smatrao da su dokazi koji podupiru odobrenje omega-3 za sekundarnu prevenciju nakon infarkta miokarda imali stanovita metodološka ograničenja i da su bili slabe razine.