Vol 1, No 1 (2010)

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).

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.

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.

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.

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).

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.

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.