Vol 4, No 1 (2013)

Articles
Chronic obstructive pulmonary disease and arterial hypertension: methaphysics and dialectic
Li V.V., Zadionchenko V.S., Adasheva T.V., Pavlov S.V., Shakhrai N.B.
Abstract
The paper provides a review of prevalence and outcomes of cardiovascular comorbidities in patients with chronic obstructive pulmonary disease (COPD). From a clinical and patient-centered perspective, a COPD phenotype should be able to classify patients into distinct subgroups that provide prognostic information and allow to better determine appropriate therapy that alters clinically meaningful outcomes. It is hypothesized that both COPD and artherial hypertension (AH) have common pathway linking these comorbidities and explaining why they significantly complicate the management and influence the prognosis of patients with COPD and AH. Further studies will be required to explore this hypothesis and understand the relationship between COPD and AH.
CardioSomatics. 2013;4(1):5-10
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The outcomes of acute coronary syndrome and complications of acute myocardial infarction in carbohydrate metabolism disorders
Kakorin S.V., Shashkova L.S., Mkrtumyan A.M., Averkova I.A.
Abstract
Influence of carbohydrate metabolism disturbance depending on expressiveness, degree of severity and type of glucose lowering therapy to current of ischemic heart disease are presented in article. Acute coronary syndrome outcomes to Q-forming and non-Q-forming myocardial infarction, unstable stenocardia, and complications to acute left ventricular aneurysm, frequency of progress pulmonary edema were analyzed in patients with normal and impaired carbohydrate metabolism.
CardioSomatics. 2013;4(1):11-16
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Features of anti-ischemic efficacy of trimetazidine MR, assigned in combination with metoprolol in patients with angina
Bardybakhin P.Y., Bochkareva E.V., Kim I.V.
Abstract
We studied the influence of trimetazidine MR on exercise tolerance and carbohydrate metabolism in 28 patients with stable effort angina, treated with metoprolol. The addition of trimetazidine MR to ongoing therapy with metoprolol substantially enhanced the antianginal and anti-ischemic efficacy of treatment. The most significant improvement was observed when the monotherapy with metoprolol wasn’t effective. In this subgroup of patients the threshold exercise duration increased by 77,1±18,1 s (p<0,05), the angina frequency decreased by 5,0±2,3 attacks per week (p<0,001) in comparison with metoprolol. Trimetazidine MR didn’t change the fasting blood glucose and insulin level and the index of fasting insulin resistance HOMA2-IR.
CardioSomatics. 2013;4(1):16-20
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Expression of proinflammatory cytokines in stable angina
Zakirova A.N., Zakirova N.E.
Abstract
Objective: to evaluate the severity of immuno-inflammatory responses under stable stenocardia in patients with ischemic heart disease (IHD). Patients and intervention: the study included 83 patients suffering from IHD. Among them 30 cases were diagnosed as functional class (FC)-II stenocardia, 27 cases as FC-III stenocardia and 26 cases as FC-IV stenocardia. The control group included 25 healthy persons. For characterizing the immuno-inflammatory responses we examined the level of C-reactive protein (CRP), pro-inflammatory (IL-1b, IL-6, TNF-α) and anti-inflammatory (IL-4, IL-10) cytokines by the immunoenzymic procedure. Results: FC-II stenocardia showed normal levels of CRP and pro-inflammatory cytokines. FC-III stenocardia was associated with a moderate increase in markers of an inflammation. FC-IV stenocardia was characterized by maximum levels of CRP and pro-inflammatory cytokines. Conclusion. The intensity of immuno-inflammatory responses depends on more or less serious course of stenocardia in patients with IHD.
CardioSomatics. 2013;4(1):20-23
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Methodological issues in the organization and implementation of outpatient rehabilitation exercise programs in patients with different forms of coronary heart disease
Aronov D.M.
Abstract
The paper presents a review of the main features of a program of the exercises used in the medical rehabilitation of patients with acute and chronic coronary heart disease, including conditions after operations on the heart and vessels. Based on his and literature information, the author states that it is now accepted to use low - to moderate-intensity training exercises. They do not differ from high-intensity exercises in their effectiveness. Furthermore, they are safe, more economical, and convenient. The author gives particular attention to the organizational issues of physical rehabilitation, particularly to multi-sessional trainings using the computerized trainer system.
CardioSomatics. 2013;4(1):23-28
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Statins in the treatment and the prevention of the progression of atherosclerosis of patients with coronary heart disease
Morozova T.E., Vartanova O.A.
Abstract
Statins, the most common drugs to lower lipid levels, are «strategic» products for the treatment of patients with coronary heart disease (CHD), atherosclerosis, having the ability to reduce the cardiovascular and total mortality. This class of drugs can slow down the course of atherosclerosis and makes it more benign. A special place among statin places rosuvastatin (Crestor®, «AstraZeneca») due to his number of advantages of pharmacological and clinical properties. Compared with other statins, he has a far more powerful inhibition of the enzyme by metansulfonilamidnoy group and the most hypolipidemic activity (reduction of LDL cholesterol by 45–50% from baseline) in combination with the good tolerability and economic advantages.
CardioSomatics. 2013;4(1):28-35
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Efficacy of a combination of cholesterol absorption and synthesis inhibitors in the correction of hyperlipidemia and dietary fat intolerance in patients with coronary heart disease (ESTHETICS trial)
Bubnova M.G., Perova N.V., Aronov D.M., Zeinapur A.A., Ozerova I.N.
Abstract
Objective: to study the lipid-modifying effects of the selective intestinal cholesterol absorption inhibitor ezetimibe as monotherapy and in combination with simvastatin, an inhibitor of hydroxy methyl glutaryl coenzyme A (HMG-CoA) reductase, a key enzyme in cholesterol synthesis, which is given on an empty stomach and after single dietary fat intake (FI) that modulates postprandial hyperlipidemia (HL) in coronary heart disease (CHD) patients with baseline HL. Subjects and method. The trial covered 30 patients aged 43–75 years with CHD and baseline HL of Types IIa and IIb (Fredrickson classification) who were, after 4-week therapy, randomized to 2 groups: 1) 15 patients took ezetimibe 10 mg/day and 2) 15 received simvastatin 20 mg/day (the total duration of monotherapy was 12 weeks), then its half dose (from 20 to 10 mg/day) added by ezetimibe 10 mg/day (the duration of the combination therapy was 12 weeks). All the patients underwent standard FI test before and after a 12-week monotherapy period and 24 weeks (i.e. after 12-weel combination therapy). A standard FI test was carried out by the modified procedure described by J. Patsch (1983); the cutoffs for blood sampling for analysis were on an empty stomach (before FI) and 3 and 6 hours after FI. Results. The patients with CHD treated with ezetimibe 10 mg showed a significant reduction in the fasting levels of total cholesterol (TC) by 20% (p<0,001), low-density lipoprotein cholesterol (LDL-C) by 25% (p<0,001), triglycerides (TG) by 25% (p<0,01), and apolipoprotein B by 20% (p<0,001). Ezetimibe monotherapy resulted in a significant decrease in the postprandial concentrations of TC and non-high-density lipoprotein cholesterol (non-HDL-C). A combination of hypolipidemic drugs (ezetimibe 10 mg + simvastatin 10 mg) provides an additional positive effect in lowering the postprandial (at 6 hours of FI) concentrations of TC by 9,1% (p<0,001) and non-HDL-C by 10,9% (p<0,001). The time course of changes in the levels of TG was significantly unchanged in response to FI while its mean postprandial levels were lower than those before treatment. The atherogenic TC/HDH-C ratio was reduced: its value decreased after FI by 40,3% (p<0,001) at 6 hours relative to the baseline values. Conclusion. Monotherapy with ezetimibe and simvastatin and, to a greater extent, their combination alleviate postprandial HL that is of greater importance in atherogenesis than the isolated increase in serum LDL-C. This noticeably enhances lipid-transporting system resistance to the atherogenic effect of dietary fats in patients with CHD.
CardioSomatics. 2013;4(1):35-43
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Smoking and cardiovascular system
Barbarash N.A., Barbarash L.S., Barbarash O.L., Barbarash S.L., Zavyrylina I.N.
Abstract
The article is a review of modern data about quantity of smoking people in the whole world and in Russia, in particular among physicians. The influence of smoking on cardiovascular system, its diseases and their pathophysiologic mechanisms is described.
CardioSomatics. 2013;4(1):44-47
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Self-monitoring of blood glucose as a basis for diabetes management
Mayorov A.Y., Melnikova O.G., Filippov Y.I.
Abstract
The article represents the review of issues of self-monitoring of blood glucose (SMBG) in diabetes treatment. The therapeutic purposes are considered when carrying out SMBG before and after the meals, accepted in Russia, providing an individualization depending on age, existence of severe complications and the risk of hypoglycemia. SMBG frequency is presented at various options of the antidiabetic therapy. The value of carrying out SMBG for the patient and the doctor is discussed. The principles of the work photometric and electrochemical glucometers are given. Issues of accuracy of blood glucose measuring accepted by the International organization for standardization for the systems of SMBG are presented. The reasons of errors to the system evaluation of blood glucose are connected with incorrect hand washing, improper coding of test strips, external conditions (altitude, temperature, humidity), hematocrit, acidosis, hyperlipidemia, concentration of oxygen in blood, exogenous interfering substances (some medicines). The structure and rules of maintaining the diary as the main way of the storage of results of SMBG are presented. Data of the international and Russian studies on an assessment of efficiency of SMBG are shown. The SMBG new methods are discussed in the section on continuous glucose monitoring.
CardioSomatics. 2013;4(1):47-54
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Clinical efficacy of various forms of continuing education of patients with chronic heart failure
Arutyunov G.P., Evzerikhina A.V., Rylova A.K., Lobzeva V.I.
Abstract
Data from numerous epidemiological studies indicate that in many developed countries, heart failure is one of the most common, progressive and predictive of adverse complications of diseases of the cardiovascular system. At the moment, that is a rather acute problem of cardiac rehabilitation of such patients. The purpose of our study was to investigate the effect of various forms of structured learning in special schools for CHF patients on the clinical course and prognosis. Materials and Methods: This study consisted of two phases, including 158 patients with chronic heart failure II–III FC. Evaluated the survival of the knowledge, clinical status, distance of a 6-minute walk, Minnesota QoL questionnaire, adherence to therapy, the frequency of hospital admissions for heart failure decompensation, referral to the clinic, the frequency of deaths, the level of CRP, LV function the results of echocardiography. The results: the use of interactive learning will significantly improve patient compliance to treatment (D=5%), which in turn significantly improved the clinical condition of patients, quality of life, performance test, 6-minute walk, and left ventricular function, as well as reduced the number of hospitalizations with circulatory decompensation (1,6-times), and uptake to the clinic (up to 0,5 times a month). Thus, the use of interactive patient education is an integral part of the cardiorehabilitation events in patients with CHF.
CardioSomatics. 2013;4(1):55-62
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Capacities of the current angiotensin-converting enzyme inhibitor zofenopril in clinical practice: cardioprotective, anti-ischemic, and antiatherogenic effects
Bubnova M.G.
Abstract
The given review discusses the use of angiotensin-converting enzyme (ACE) inhibitors in patients with cardiovascular diseases, including those with prior acute myocardial infarction. The paper places particular emphasis on the currently available ACE inhibitor zofenopril. It discusses its special pharmacological properties and considers its additional effects associated with cardioprotective, anti-ischemic, antiatherogenic effects. The review provides a rationale for the clinical efficacy of zofenopril and a possibility for its wider clinical application.
CardioSomatics. 2013;4(1):62-71
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The clinical and economic efficiency of treatment in patients with chronic heart failure
Tarlovskaya E.I., Malchikova S.V.
Abstract
Objective: to study the clinical and economic benefits of adding ivabradine to standard therapy for chronic heart failure (CHF). Subjects and methods. A clinical and economic analysis of the pharmacoeconomic efficacy of ivabradine (Coraxan Servier, France) in patients with CHF was made using the Markov simulation on the basis of the SHIFT trial. The cost-utility ratio (CUR) was calculated by the formula: CUR=DC/Ut, where DC is the direct cost of treatment; Ut is the cost utility expressed in life-years gained (LYG) and quality-adjusted life years (QALY). While calculating the latter, the model used the utility value derived in the SHIFT-PRO trial, by applying the EQ-5D questionnaire. Results. The monthly cost of standard pharmacotherapy was 799,14 rbl. per person. The treatment involving ivabradine cost 1807,77 rbl. The mean total direct cost for treating one patient was 64 741,09 and 47 647,83 rbl. in the ivabradine and placebo groups, respectively. The costs of hospital stay were ascertained to constitute 60% of all the direct costs in patients receiving standard therapy. On the contrary, addition of ivabradine to standard therapy allows avoidance of 309 admissions for worsening CHF, which permitted 23 709 879 rbl. to be saved. Reducing the costs of hospitalization enables one to spend 67% of the means for pharmacotherapy. Following a 10-year simulation period, the standard therapy remains more inexpensive than therapy involving ivabradine (74 585,31 rbl. per person versus 120 843,30 rbl per person) and ensures the lower cost of one LYG and one QALY. At the same time, the therapy added by ivabradine can prevent 1300 admissions for CHF and about 500 deaths per 10,000 patients over 10 years. This will lead to more life-years gained (4,277 LYGs on ivabradine therapy versus 4,083 LYGs on standard therapy), including quality-adjusted life years (3,031 QALYs on ivabradine therapy versus 2,839 QALYs on standard therapy). When ivabradine was added to standard therapy, the cost of one LYG was 238 443 rbl. and that of QALY was 240 927 rbl. Thus, the estimated medical intervention is a cost-effective investment. Conclusions: 1. To enhance the efficiency of CHF treatment with ivabradine causes a rational change in the cost structure. 2. To reduce the costs of hospitalizations and to change the cost structure provide a possibility of increasing those of qualitative therapy. 3. To incorporate ivabradine in therapy for systolic CHF can gain more additional life years, including quality-adjusted life years. 4. To increase expenses on therapy involving ivabradine per LYG is a cost-effective investment.
CardioSomatics. 2013;4(1):72-76
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Otvety k klinicheskoy zadache (keysu), opublikovannoy v predydushchem nomere
Parnes E.Y.
Abstract
CardioSomatics. 2013;4(1):76-78
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