Vol 1, No 1 (2010)


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A real way of reducing coronary heart disease mortality in Russia

Aronov D.M., Bubnova M.G.


The paper analyzes reasons for high cardiovascular mortality in Russia and states that therapeutic work done by primary practitioners is ineffective. It gives the statistical data of the European Union, the USA, and some other countries where overmortality from cardiovascular diseases has been overcome by the governmental cardiovascular prevention and rehabilitation system. It is concluded that the experience of these countries can be applied to reduce cardiovascular overmortality in Russia
CardioSomatics. 2010;1(1):11-17
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Issledovanie ZAFRA (ZAFRA study: Zanidip en Funcion Renal Alterada): Lerkanidipin u patsientov s KhPN

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Цели исследования Оценить безопасность использования лерканидипина у пациентов с хронической почечной недостаточностью (ХПН). Изучить нефропротективный эффект лерканидипина у пациентов с ХПН, находящихся на терапии ингибиторами ангиотензинпревращающего фермента (ИАПФ) или блокаторами рецепторов ангиотензина II (БРА).
CardioSomatics. 2010;1(1):18
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Current approaches to rehabilitation of patients with chronic heart failure

Arutyunov G.P., Kolesnikova E.A., Rylova A.K.


The paper provides a critical review of the specific features of treatment in patients with Functional Class III-IV chronic heart failure (CHF). In addition, the authors give the positive results of their own studies dealing with respiratory muscle training in CHF. Greater treatment adherence by a patient is promoted by the attraction of his/her relatives to the treatment process. For wider involvement of physicians in the problem, the authors arranged a Russian study to increase the adherence of patients with CHF to treatment and rehabilitation, by attracting patients’ relatives to this process.
CardioSomatics. 2010;1(1):20-24
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How the results and pattern of treatment have recently changed in patients with acute myocardial infarction (according to the data of two Saint-Petersburg hospitals)

Bolduyeva S.A., Bykova E.G., Leonova I.A., Trostyanetskaya N.A., Yarmosh I.V., Tretyakova N.S., Nesterko A.O.


The results and pattern of therapy were analyzed in 772 patients with acute myocardial infarction (AMI) who were treated at two Saint Petersburg hospitals in 1998 to 2007. A follow-up indicated that drug treatment quality and therapy adherence improved a year after AMI, resulting in a significant reduction in sudden cardiac death rates. At the same time, inadequate primary myocardial reperfusion and myocardial revascularization failed to significantly reduce mortality from chronic heart failure and incidence of myocardial reinfarction. Key words: acute myocardial infarction, sudden cardiac death, myocardial reinfarction, guidelines for the management of myocardial infarction, drug therapy adherence.
CardioSomatics. 2010;1(1):25-30
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Arterial hypertension and chronic obstructive pulmonary disease: pathogenetic parallels and clinicofunctional features

Zadionchenko V.S., Adasheva T.V., Fedorova I.V., Pavlov S.V., Li V.V., Nesterenko O.I.


The great prevalence of comorbidities, such as arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD), generates a need to study the impact of COPD on the pathogenesis, course, and clinical picture of associated cardiovascular diseases. The paper analyzes the data available in the literature on the pathogenesis and course of arterial hypertension in patients with COPD. The paper also gives the authors’ data on the clinicofunctional and pathophysiological features of AH in patients with COPD. The findings suggest that the study group has clinical vascular and organ dysfunction that may both play a role in the pathogenesis of AH in the presence of COPD and prevent a high cardiovascular risk. Key words: arterial hypertension, chronic obstructive pulmonary disease.
CardioSomatics. 2010;1(1):31-37
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Hypolipidemic therapy in patients with non-alcoholic fatty liver disease

Lazebnik L.B., Zvenigorodskaya L.A., Samsonova N.G., Cherkasova E.A., Melnikova N.V.


Dyslipidemia is currently accepted to be one of the major risk factor for cardiovascular diseases and atherosclerosis. There is no question that the liver plays an important role in the development of atherogenic dyslipidemia and it is simultaneously a target organ, which results in the development of non-alcoholic fatty liver disease (NAFLD). The latter limits the feasibilities of adequate hypolipidemic therapy, thus increasing the cardiovascular risks. There is a need to use hepatoprotectors when atherogenic dyslipidemia in a patient with documented NAFLD is treated with statins and fibrates. The choice of hepatoprotectors depends on the stage of NAFLD. It is expedient to take statins in combination with ursodeoxycholic acid preparations in NAFLD at the stage of steatosis. A combination of statins and a cholesterol absorption inhibitor is more effective in achieving low-density lipoprotein cholesterol goals in patients with hypercholesterolemia. Intestinal microflora-normalizing agents (enteric antiseptics, pre- and probiotics) should be included into a complex of hypolipidemic therapy in patients with NAFLD. Key words: atherogenic dyslipidemia, non-alcoholic fatty liver disease, hypolipidemic therapy.
CardioSomatics. 2010;1(1):38-45
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Cardiovascular diseases in diabetic patients

Yarek-Martynova I.Y., Shestakova M.V.


The review pays attention to a considerable rise in the incidence of diabetes mellitus (DM) and to its association with cardiovascular diseases (CVD) and events. It is noted that these events may be present much earlier than DM is diagnosed. The paper also discusses in detail a role of hyperglycemia, postprandial one in particular, hyperinsulinemia, insulin resistance, endothelial dysfunction, impaired blood rheological properties, lipid metabolic disturbances, and genetic and traditional risk factors in the development of atherosclerosis, coronary heart disease, chronic heart failure, cerebrovascular diseases, and lower extremity ischemia in DM.
CardioSomatics. 2010;1(1):46-50
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Comprehensive rehabilitation of patients with coronary heart disease concurrent with anxiety and depression disorders

Repin A.N., Lebedeva E.V., Sergienko T.N., Karpov R.S.


In cardiological inpatients, coronary heart disease (CHD) is concurrent with clinical anxiety and depression disorders in 43% of cases. Comorbidity of coronary disease and anxiety and depression disorders is more frequently encountered among women than among men (40 versus 22%) and among post-aortocoronary bypass patients. Depressive disorders substantially worsen the course of CHD due to the frequent development of myocardial infarction, low exercise endurance, and patients’ refusal to have endovascular and surgical treatments. Therapy with selective serotonin reuptake inhibitor (SSRI) antidepressants caused a reduction in anxiety and depression disorders along with the improved clinical course of CHD, as evidenced from angina pectoris and heart failure. No serious side effects were observed during continuous SSRI use. The proposed regimen for the joint follow-up, treatment, and rehabilitation of patients by a working group of cardiologists and psychiatrists within a biopsychosocial model of rehabilitation is effective. It may be extensively used in cardiology, in the outpatient setting in particular.
CardioSomatics. 2010;1(1):51-56
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Study of the efficiency and safety of Ladasten therapy in patients with cardiovascular disease

Kopylov F.Y., Nikitina Y.M., Makukh E.A., Syrkin A.L.


A trial was carried out to study the efficiency and safety of therapy with the new antiasthenic drug Ladasten. The findings suggest its high safety and efficiency and good tolerability of Ladasten in the treatment of asthenia and asthenic spectrum disorders, the development of which is associated with cardiovascular disease.
CardioSomatics. 2010;1(1):57-61
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Medicines in the rehabilitation of patients after myocardial infarction: angiotensin-converting enzyme inhibitors

Galyavich A.S.


The paper analyzes the use of angiotensin-converting enzyme (ACE) inhibitors in patients after prior myocardial infarction. It presents the data of controlled studies, which indicate that it is warranted to use ACE inhibitors to improve prognosis in patients. It is concluded that it is unreasonable for a physician not to prescribe ACE inhibitors to post-myocardial infarction patients with obvious or asymptomatic left ventricular dysfunction and to diabetic patients (if no contraindications).
CardioSomatics. 2010;1(1):62-64
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Hemodynamic and endothelium-protective effects of β-adrenoblockers in patients with coronary heart disease complicated by chronic heart failure and atrial fibrillation

Zakirova A.N., Abdyukova E.R., Zakirova N.E.


Aim. To elucidate effect of b-adrenoblockers on remodeling of myocardium and adhesive function of endothelium in with ischemic heart disease with chronic heart failure (CHF) and addition of atrial fibrillation (AF). Material and methods. We included into the study 77 patients with functional class II–III CHF and AF of ischemic genesis randomized in 2 groups, In group 1 were included 40 patients who during 24 weeks used carvedilol at the background of basic therapy, in group 2–37 patients receiving metoprolol tartrate. In the work we used clinico-instrumental (echocardiography, test with 60 minute walk), immunoenzymatic (soluble intercellular adhesion molecules (sVCAM, SE – selectin) methods of investigation. Results. Application of both BAB improved clinical state and physical working capacity of patients with CHF and AF. Carvedilol more significantly than metoprolol tartrate prevented remodeling of myocardium, inhibited expression of cellular adhesion molecules. Levels of sE-selectin and VCAM-1 decreased under action of carvedilol. Conclusion. Carvedilol in long term therapy of CHF with AF exerts substantial influence on adhesive function of endothelium and improves hemodynamics.
CardioSomatics. 2010;1(1):65-69
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Contribution of traditional risk factors to 10-year survival in elderly male patients with coronary heart disease

Volkova E.G., Tantsyreva I.V.


Aim. To estimate the contribution of traditional risk factors to the prediction of fatal outcomes in elderly and senile male patients with coronary heart disease (CHD). Subjects and methods. A 10-year prospective cohort study (from early 1997) included 167 male CHD patients aged 60 years or older (mean age 76,3±0,5 years); a comparison group comprised 38 males (mean age 76,9±1,06) with chronic obstructive pulmonary disease (COPD) without clinical and other signs of CHD. A control group consisted of 32 males over 60 years old without signs of cardiovascular and pulmonary diseases, who had been admitted to the therapeutic unit of the same clinic during the same period. The examined patients were followed up for 10 years, by analyzing the disease course and monitoring fatal events. Results. The probability of predicting 10-year cardiovascular mortality significantly increased the presence of arterial hypertension and low physical activity (OR, 1,67; CI, 1,11–2,51; p=0,01 and OR, 1,454; CI, 1,091–1,393; p=0,01). Elevations of systolic blood pressure up to 150 mm Hg or higher increased the risk of death from all causes in the examined males with CHD by 1.37-fold (p<0,05), from cardiovascular causes by 1,65-fold (p<0,05), chronic forms of CHD by 2,01-fold, acute myocardial infarction by 8-fold (p<0,05), and stroke by 2.13-fold. When obesity was concurrent with arterial hypertension, the likelihood of death was higher than when only a factor of obesity was present and was lower when arterial hypertension was. A combination of smoking and arterial hypertension increased the relative risk of death by 2.6 times. The maximum likelihood of death was found when there was a combination of arterial hypertension and low physical activity (p=0,02). The contribution of overweight only and smoking only (without combination with other risk factors) to cardiovascular mortality was insignificant. Conclusion. Thus, the higher spread of risk factors other than smoking was revealed in the examined patients with CHD and COPD than that in apparently healthy individuals. The contribution of traditional risk factors to cardiovascular mortality in elderly and senile males with existing CHD varies. Assessment of each factor permits prediction of the rate of disease progression, the development of complications, and clinical outcomes.
CardioSomatics. 2010;1(1):70-74
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Predictors of cardiovascular events in patients with chronic heart disease after surgical myocardial revascularization (according to the data of a long-term observation)

Shalayev S.V., Arutyunyan L.A.


Aim. To elucidate independent predictors of fatal and nonfatal cardiovascular events in patients with chronic heart disease (CHD) after surgical myocardial revascularization during a long-term prospective observation. Subjects and methods. The study enrolled 120 patients with CHD who had undergone coronary artery bypass grafting with extracorporeal circulation. Further 2-5-year follow-ups recorded deaths from cardiac causes, including sudden deaths, as well as the incidence of nonfatal cardiovascular events (myocardial infarction, stroke). Results. The mean follow-up time was 36±5 months. During the follow-ups, there were 12 deaths: 1 and 8 deaths from pneumonia and myocardial infarction, respectively; 3 patients died suddenly. Out of the nonfatal events, myocardial infarction and stroke were recorded in 7 and 2 cases, respectively. Stepwise regression analysis showed that the independent predictors of fatal cardiac events were as follows: 1) an ejection fraction of less than 40% (relative risk 5.7 with deviations within 95% confidence interval, 1,2–10,7); 2) age of 70 years or older (4,9; 1,4–8,4); 3) diabetes mellitus (2,3; 1,1–3,7); 4) left ventricular aneurysm (2,1; 1,04–3,8); 5) mechanical ventilation for more than 24 hours (2,0; 1,2–2,9); 6) chronic obstructive pulmonary disease (1,9; 1,1–3,1). The independent predictors of all cases of both fatal and nonfatal cardiovascular events were: 1) age of 70 years or older (4,1; 1,2–8,1); 2) an ejection fraction of less than 40% (3,7; 1,1–6,5); 3) endarterectomy during coronary artery bypass grafting (2,9; 1,1–5,4); 4) mechanical ventilation for more than 100 minutes (2,2; 1,2–3,9); damage to the brachiocephalic artery area (2,1; 1,1–6,4), prior stroke (1,8; 1,1–3,8). Conclusion. The conducted study indicated the implication of both the poor traditional predictors of CHD and comorbidity, as well as the specific features of surgical intervention and anesthetic maintenance in the development of further fatal and nonfatal cardiovascular events in patients with CHD after surgical myocardial revascularization.
CardioSomatics. 2010;1(1):75-79
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Genetic predisposition to atherothromboses in patients with severe angina pectoris

Chumakova G.A., Momot A.P., Kozarenko A.A., Veselovskaya N.G.


Objective. To study the prevalence of thrombosis allelic polymorphisms in patients with severe angina who have indications for myocardial revascularization. Design and methods. The study included 105 patients (87 men and 18 women) aged from 33 to 70 years who had angina III–IV functional class, with indications for myocardial revascularization. All the patients studied polymorphism of the inhibitor of tissue plasminogen activator I type (675 4G/5G) (PAI-I), mutations of the factor II-prothrombin (20210 G / A), mutations of the factor V Leiden (Arg 506 Gln) and polymorphism of the methylenetetrahydrofolate reductase (Ala 222 Val) (MTHFR). Results. The prevalence of these mutations and polymorphisms in patients with severe angina requiring revascularization of the myocardium in 3 times greater than in the group of healthy adolescents. Our data showed that the risk of severe angina is directly proportional, and the age of the clinical debut of CHD is inversely proportional to the number of studied genetic defects. Thrombophilic polymorphisms studied genes increases the effects of other cardiovascular risk factors such as male sex, smoking and leads to an earlier debut of clinical CHD. Conclusion. It is necessary to form the strategy of genetically-based population policy for the prevention of atherosclerosis, including coronary. Healthy persons with diagnosed thrombosis polymorphisms are need of active primary prevention of cardiovascular disease.
CardioSomatics. 2010;1(1):80-83
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CardioSomatics. 2010;1(1):86
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