Vol 8, No 2 (2017)

Aim. To study psychoemotional status and serum cortisol changes in patients with arterial hypertension (AH) and obesity, depending on the level of physical activity. Material and methods. 76 male patients with AH stage I and II were examined. Group 1 consisted of 36 patients with AH and obesity, group 2 - 40 hypertensive patients without obesity. Serum cortisol level was determined by enzyme-linked immunosorbent assay. To access level of psycho-emotional strain in patients PSM-25 scale was used. The level of reactive and personal anxiety was measured using a Spielberger-Khanin questionnaire. To assess physical activity a brief international physical activity questionnaire (IPAQ) was used. Results. Each group was divided into two subgroups depending on the level of physical activity. According to results of psychological questionnaires physically inactive patients showed significantly higher levels of psychoemotional stress and serum cortisol concentrations as compared to physically active patients. There was an inverse correlation between the level of physical activity with reactive anxiety in group 1 (r=-0.35; p=0.04), and between physical activity with personal anxiety (r=-0.36; p=0.02) and psychoemotional strain in group 2 (r=-0.42; p=0.006). There also was an inverse association between the level of physical activity with systolic (group 1 - r=-0.52; p=0.001; group 2 - r=-0.52; p=0.0006) and diastolic (group 2 - r=-0.45; p=0.004) blood pressure. All groups showed an inverse relationship between physical activity level and serum cortisol concentration that was statistically significant in group 2 (r=-0.36; p=0.04). Conclusion. Our results support the hypothesis that regular physical activity confers resilience by oftimizing physiological and neuroendocrine responses and acts as a buffer against stressors.

Purpose. Study of the clinical effectiveness of a long-term (one-year) physical rehabilitation program with the inclusion of physical training (PT) in the III (polyclinic) stage of cardiac rehabilitation in patients with ischemic heart disease of working age who underwent acute myocardial infarction (AMI), depending on the status of smoking. Materials and methods. The study included men (n = 241, mean age 51.3 ± 2.2 years) who underwent AMI (no earlier than 3 weeks from the event). Patients were randomized into 2 groups: the main ("O") - 126 people and the control ("K") - 115 participants. All patients received standard medication. In the "O" group, PT was used in the medium intensity regime (50-60% of the fulfilled capacity with a load sample) 3 times a week for one year. Each of the groups was divided into two subgroups, depending on the status of smoking. Effectiveness of the effect was assessed by clinical data and results of instrumental-laboratory analysis. Results. After a yearly PT, a significant increase in physical performance was observed in smokers (n=41) and nonsmokers (n=41) and nonsmokers (n=85) after IMI: an increase in the duration of the load (by 30.3%, p<0.001 and 28.4%, p<0.001) and its power (by 31.2%, p<0.001 and 30.8%, p<0.001) against the backdrop of an increase (by 3.8%, p<0.01) in the economics of physical work, but only for smokers. In the absence of PT, only in nonsmokers (n=72) after AMI, there was an increase in the duration of the load (by 10.1%, p<0.01) and its power (by 11.1%, p<0.05), but to a lesser extent than non-smoking trained patients. In smoking patients (n=43), in the absence of PT, there was no change in the Fed indicators, on the contrary, there was a decrease in the cost-effectiveness of the work performed (by 13.3%, p<0.05). The level of daily motor activity increased only against the background of PT among smokers by 22.2% (p<0.001) and non-smokers by 19.4% (p<0.01). This was combined with a decrease in heart size and increased contractility of the left ventricular myocardium in smokers and non-smokers, but more pronounced positive changes in the background of PT were seen in non-smoking patients. There was no positive dynamics of echocardiographic parameters in the absence of PT, although a slight increase (by 1.9%, p<0.05) of the left ventricular ejection fraction was observed in nonsmokers. Only in the background of PT, smoking and non-smoking patients (equally) had a decrease in the levels of atherogenic lipids and an increase in the concentration of high-density lipoprotein cholesterol by 18.2% (p<0.05) and 20% (p<0.05), respectively. In smoking patients without PT, on the contrary, there was an increase (by 12.5%, p<0.05) of the level of triglycerides. PT had anti-ischemic effects, manifested in a reduction in angina attacks and the need for nitroglycerin consumftion in smokers and non-smokers, in contrast to untrained patients. After the year of PT, the development of all cases of cardiovascular complications significantly decreased in the subgroup of smokers by 44.8% (p<0.05) and the non-smoking group by 50.9% (p<0.05), and the number of days of temporary incapacity for work Per patient decreased by 2 days for smokers and 2.6 days for non-smokers. The conclusion. Long-term (annual) PT of medium intensity at the third outpatient stage of cardiac rehabilitation in both smokers and non-smokers who underwent AMI provides a stable course of the disease, reduces the likelihood of developing cardiovascular complications, improves the patient's quality of life and is safe in the vast majority. At the same time, smoking should be considered as a factor that reduces the rehabilitation potential of the patient who has undergone AMI and prevents better results in cardiac rehabilitation.

The review is devoted to the role of ivabradinum in the procedure of percutaneous coronary intervention (PCI) in patients with ischemic heart disease with stable angina. It is reported that reperfusion of the myocardium with PCI, even in combination with modern drug therapy, does not have a complete clinical effect. The authors substantiate the possibility of completing the clinical effect of PCI in such patients by prescribing ivabradinum. The drug reduces the heart rate more than with medication without it.

The review presents the main provisions of the current recommendations of the European and American communities on the diagnosis and treatment of atherogenic dyslipidemia. Evidence of the importance of reducing the level of low-density lipoprotein cholesterol as a key factor in the development of cardiovascular diseases caused by atherosclerosis and the primary goal of lipid lowering therapy are given. Unresolved problems of statin therapy are indicated. A characteristic of a new class of lipid-lowering drugs is the inhibitors of the subtilisin/kexin type 9 proprotein convertase (PCSK9). The results of the first large studies with the PCSK9 inhibitor evoloucumab were discussed, which allowed to formulate the main indications for the prescriftion of this group of drugs in clinical practice.

This article gives an overview of the scientific evidence on the impact of physical activity on various parameters of the health of people with end-stage renal disease. With examples of clinical observations, interrelations are established between nutritional status, menstrual disorders, osteopenia, erectile dysfunction and the impact on them of methods of physical rehabilitation.

Two cases of medical care for patients with acute coronary syndrome are discussed, in which conservative and invasive treatment strategies were applied. The clinical aspects of thrombolytic therapy and percutaneous coronary interventions, the use of antiplatelet agents and anticoagulants for the prevention of atherothrombotic events after the restoration of blood flow through the infarct-responsible coronary artery are considered.