Vol 10, No 1 (2019)

Aim. To study cardiopulmonary relationships in patients hospitalized for acute coronary syndrome with concomitant chronic obstructive pulmonary disease (COPD). Materials and methods. Based on having/not having of COPD exacerbation on admission. 52 patients (29 men and 23 women) were divided into 2 groups: group 1 (n=33) with COPD exacerbation and group 2 (n=19) without COPD exacerbation. Patients examination inclused spirometry with bronchodilator test and identification of serum troponin T (TnT) levels. Results. In 30 patients TnT levels confirmed a development of acute myocardial infarction (AMI) and in 22 patients TnT levels were below the diagnostic threshold. In patients with AMI mild-to-moderate COPD was prevalent (70.0% out of all cases) and exacerbation of COPD was diagnosed in 76.7% of patients on admission. TnT levels in patients with both AMI and an exacerbation of COPD were significantly higher compared to those in patients without COPD exacerbation: 0.78±0.17 and 0.59±0.14 ng/ml, respectively (p=0.014). Patients without AMI and with COPD exacerbation had higher TnT levels compared to patients without COPD exacerbation: 0.19±0.08 and 0.11±0.04 ng/ml respectively (p=0.002). Conclusion. Thus concomitant COPD, especially with acute exacerbation, is associated with an increased risk of AMI in patients hospitalized with acute coronary syndrome.

Aim. The purpose of the study is to conduct a comparative analysis of the effectiveness of physical aerobic training in the mode of interval and constant loads in patients who have had a myocardial infarction with subsequent percutaneous coronary intervention. Materials and methods. 35 patients aged from 46 to 67 years old were examined in the process of passing a 3-week course of physical rehabilitation in a day hospital. Of these, 18 people (group 1) performed daily training on cardiovascular machines in the mode of interval loads, 17 people (group 2) - in the mode of moderate loads with constant intensity. Results. When conducting physical training in different training regimens, both groups of patients showed an improvement in exercise tolerance. At the same time, the interval training as compared to the constant intensity training provided a more pronounced training effect on the cardiorespiratory system due to high-intensity loading phases and at the same time a low level of hemodynamic load due to the presence of relatively low-intensity phases. Conclusion. Interval training is preferred in patients who have had a myocardial infarction followed by percutaneous coronary intervention, due to their high efficacy and safety.

Aim. To describe a role of self-monitoring of glycemia in a treatment of diabetes mellitus (DM) and in a prevention of vascular complications of DM. Materials and methods. Data of 57 scientific sources from Russian and foreign literature published within 2005-2017 are considered. Results and conclusions. DM is a chronic disease associated with a development of micro- and macrovascular complications and to prevent them is an important task of modern medicine. In patients with DM an incidence of cardiovascular diseases is 2-3 times higher compared with the general population. Hyperglycemia is among the major damaging factors for the cardiovascular system. Clinical studies have clearly demonstrated that programs of therapeutic management of diabetic patients which include regular self-monitoring of glycemia lead to a better reduction of glycated hemoglobin levels compared to programs without self-monitoring as well as they help many patients to avoid late complications. СКГ rate is correlated with glycated hemoglobin levels. Regular self-monitoring allows you to avoid sudden and dangerous fluctuations in glycemia, including hypoglycemia, which contribute to high cardiovascular risk. The use of self-monitoring of glycemia in combination with structured patient education is associated with improving the quality of life of patients with DM. Current view on self-monitoring implies a certain frequency of blood glucose systematic measurement (varies depending on the type of glucose-lowering therapy and the degree of diabetes compensation) and is an important reference point used by both the doctor and the patient to assess a treatment outcome and to correct it if necessary. An availability of modern glucometers and skills of their correct and regular use turn a patient into an active and valuable participant in a management of DM. Achieving and maintaining the target glycemia levels depends largely on an accuracy of the glucometer since measurement results provide the basis for changing a glucose-lowering therapy if necessary. From the physician's point of view, the most important criterion for selecting a glucometer is compliance with the accuracy standards, and from the patient’s point of view this is convenience and ease of use. Thanks to improving technologies that increases an accuracy of blood glucose measurements, the procedure for self-monitoring of glycemia is simplified, which contributes to glucose-lowering therapy effectiveness and treatment compliance.

Aim. To provide a current view on the tolerability and safety of statin therapy. Materials and methods. The data of 73 scientific sources from Russian and foreign literature published within 1996-2018 are considered. Results. It is generally accepted that statins are first-line therapeutic agents for hypercholesterolemia and combined hyperlipidemia. Today there in growing evidence that lowering of low-density lipoprotein cholesterol levels prevents atherosclerotic diseases and reduces a risk of cardiovascular and overall mortality. Main issues of current statin therapy include a use of inadequate dosage for atherosclerotic diseases prevention, low treatment compliance and drug intolerance. In recent years the issue of statin intolerance has become of great importance. Criteria were proposed for determining an inability to tolerate statins, some experts suggest replacing definition of “statin intolerance” with the term “statin-associated side-effects”. Most discussed adverse effects due to statins include muscle-related symptoms (myalgia/myopathy), hepatotoxicity (hepatic hyperenzymemia) new-onset diabetes, dementia and cognitive impairment. Mechanisms of development of these adverse effects are still unclear. Certain factors and conditions capable of triggering some adverse effects as well as absolute contraindications to statin therapy were established. Some factors and conditions capable of triggering some adverse effects as well as absolute contraindications to statin therapy were identified. Occurrence of statin-associated side-effects depends on statin dose, a patient's age, gender, comorbidity and concomitant therapy. Many adverse effects of statins are drug class effect. At the same time each of statins has specific features of its structure, metabolism, drug interactions and pharmacokinetics. Pitavastatin belongs to the last generation of statins and it has distinct pharmacological features and neutral diabetogenic effects, etc. Risk of adverse effects due to statins is often exaggerated while benefit from the use of statins for preventing atherosclerotic diseases outweighs potential risks. Real occurrence of some adverse effects due to statin therapy requires additional evidence. Conclusion. Overall, statins have a good tolerability profile and are approved for use in the vast majority of patients who required lipid-lowering therapy.