Rational Pharmacotherapy in Cardiology

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Issues of pathogenesis of the calcified aortic stenosis and ischemic heart disease in the elderly are considered. The relevance of early detection of angina, syncope, and dyspnea in view of their non-specific and subclinical course for early detection of heart disease is specified. Current scientific views on the myocardial bioenergy and its role in the genesis of chronic heart failure are presented. Particular attention is paid to the place of cytoprotectors, especially trimetazidine, in the management of patients with cardiac N.Yu. Karpova1diseases.

About the Authors

N. Yu. Karpova
Pirogov Russian National Research Medical University
Russian Federation

Ostrovitjanova ul. 1, Moscow, 117997 Russia

M. A. Rashid
Moscow City Hospital №56
Russian Federation
Zagorodnoye shosse, 18A, Moscow, 117152 Russia

N. A. Shostak
Pirogov Russian National Research Medical University
Russian Federation

Ostrovitjanova ul. 1, Moscow, 117997 Russia

I. V. Pogonchenkova
Moscow City Hospital №56
Russian Federation
Zagorodnoye shosse, 18A, Moscow, 117152 Russia

T. V. Kazakova
Pirogov Russian National Research Medical University
Russian Federation

Ostrovitjanova ul. 1, Moscow, 117997 Russia


1. Global status report on noncommunicable diseases 2010. Geneva: WHO; 2011.

2. Shalnova SA, Deev AD, Karpov YA. Arterial hypertension and coronary heart disease in actual practice cardiologist. Kardiovaskulyarnaya Terapiya i Profilaktika 2006; (1): 73-80. In Russian (Шальнова С.А., Деев А.Д., Карпов Ю.А. Артериальная гипертония и ишемическая болезнь сердца в реальной практике врача-кардиолога. Кардиоваскулярная Терапия и Профилактика 2006;(1): 73-80).

3. Schukin YV, Ryabov AE. Chronic ischemic heart disease in the elderly and senile age. Manual for physicians. Samara: Volga-Business; 2008. In Russian (Щукин Ю.В., Рябов А.Е. Хроническая ишемическая болезнь сердца в пожилом и старческом возрасте. Пособие для врачей. Самара: Волга-Бизнес; 2008).

4. Kosarev VV, Babanov SA. Occupational diseases of medical workers. Samara: Ofort; 2009. In Russian (Косарев В.В., Бабанов С.А. Профессиональные заболевания медицинских работников. Самара: Офорт; 2009).

5. Karpova NY, MA Rashid, Kazakova TV, Shostak NA Aortic stenosis. Russkiy Meditsinskiy Zhurnal 2014; 22 (2): 162-5. In Russian (Карпова Н.Ю., Рашид М.А., Казакова Т.В., Шостак Н.А. Аортальный стеноз. Русский Медицинский Журнал 2014; 22(2): 162-5).

6. Lindman B.R., Bonow R.O., Otto C.M. Current management of calcific aortic stenosis. CircRes 2013;113(2):223-37.

7. Ortlepp J.R., Schmitz F., Bozoglu T. et al. Cardiovascular risk factors in patients with aortic stenosis predict prevalence of coronary artery disease but not of aortic stenosis: an angiographic pair matched casecontrol study. Heart 2003;89:1019-22.

8. Otto C., O'Brien K.D. Why is there discordance between calcific aortic stenosis and coronary artery disease? Heart 2001;85:601-2.

9. Freeman R.V., Otto C.M. Spectrum of calcific aortic valve disease: pathogenesis, disease progression, and treatment strategies. Circulation 2005;111:3316-26.

10. Karpova NY, Shostak NA, Rashid MA et al. Calcined aortic stenosis. Moscow: Media Sphere; 2011. In Russian (Карпова Н.Ю., Шостак Н.А., Рашид М.А. и др. Кальцинированный аортальный стеноз. Москва: Медиа Сфера; 2011).

11. Demer L.L. Boning up (or down) on statins. Arterioscler Thromb Vasc Biol 2001;21:1565-6.

12. Otto C.M., Kuusisto J., Reichenbach D. et al. Characterisation of the early lesion of “degenerative” valvular aortic stenosis: histological and immunohistochemical studies. Circulation 1994;90:844-53.

13. Nishimura R.A., Otto C.M., Bonow R.O. et al. 2014 AHA/ ACC Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines. Circulation 2014;129:2440-92.

14. Carabello B.A. Evaluation and management of patients with aortic stenosis. Circulation 2002;105: 1746-50.

15. Gould K.L., Carabello B.A. Why angina in aortic stenosis with normal coronary arteriograms? Circulation 2003;107:3121-3.

16. Olshansky B. Syncope: overview and approach to management. In Syncope: mechanisms and management. Armonk, N.Y.: Futura;1998.

17. Arthur W., Kaye G. The pathophysiology of common causes of syncope. Postgrad Med J 2000;76: 750-3.

18. McMurray J.J., Adamopoulos S., Anker S.D. et al. ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure. Eur Heart J 2012; 33(14):1787-847.

19. Lips D.J., DeWindt L.J., van Kraaij D.J. et al. Molecular determinants of myocardial hypertrophy and failure: alternative pathways for beneficial and maladaptive hypertrophy. Eur Heart J 2003;24: 883-96.

20. Palmieri V., Watchtell K., Gerdts E. et al. LV function and haemodynamic features of inappropriate LVH in patients with systemic hypertension. Am. Heart J 2001;141:784-91.

21. Ingwall J.S. Energy metabolism in heart failure and remodelling. Cardiovasc Res 2009;81:412-9.

22. Neubauer S. The failing heart - an engine out of fuel. N Engl J Med 2007;356:1140-51.

23. Ventura-Clapier R., Garnier A., Veksler V. Energy metabolism in heart failure, J Physiol 2004;555: 1-13.

24. Taegtmeyer H. Switching metabolic genes to build a better heart. Circulation 2002; 106:2043-5.

25. Rimbaud S., Sanchez H., Garnier A. et al. Stimulus specific changes of energy metabolism in hypertrophied heart. J Mol Cell Cardiol 2009;46:952-9.

26. Lei B., Lionetti V., Young M.E. et al. Paradoxical downregulation of the glucose oxidation pathway despite enhanced flux in severe heart failure. J Mol Cell Cardiol 2004;36:567-76.

27. Razeghi P., Young M.E., Alcorn J.L. et al. Metabolic gene expression in fetal and failing human heart. Circulation 2001;104:2923-31.

28. Leong H.S., Brownsey R.W., Kulpa J.E., Allard M.F. Glycolysis and pyruvate oxidation in cardiac hypertrophy - why so unbalanced? Comp Biochem Physiol Mol Integr Physiol 2003;135:499-513.

29. Taegtmeyer H. Genetics of energetics: transcriptional responses in cardiac metabolism, Ann Biomed Eng 2000;28:871-6.

30. Saks V., Dzeja P., Schlattner U., et al. Cardiac system bioenergetics: metabolic basis of Frank-Starling law. J Physiol 2006;571:253-73.

31. Marcil M., Ascah A., Matas J. et al. Compensated volume overload increases the vulnerability of heart mitochondria without affecting their functions in the absence of stress, J Mol Cell Cardiol 2006;41:998-1009.

32. Tsutsui H., Ide T., Kinugawa S. Mitochondrial oxidative stress, DNA damage, and heart failure. Antioxid. Redox. Signal 2006;8:1737-44.

33. Tsutsui H., Kinugawa S., Matsushima S. Mitochondrial oxidative stress and dysfunction in myocardial remodelling. Cardiovasc Res 2009;81:449-56.

34. Twig G., Elorza A., Molina A.J. et al. Fission and selective fusion govern mitochondrial segregation and elimination by autophagy. EMBO J 2008;27:433-46.

35. Dzeja P.P., Terzic A. Phosphotransfer networks and cellular energetics. J Exp Biol 2003;206:2039-47.

36. Gupta A., Gupta S., Young D. et al. Impairment of ultrastructure and cytoskeleton during progression of cardiac hypertrophy to heart failure. Lab Invest 2010;90:520-30.

37. Mudd J.O., Kass D.A. Tackling heart failure in the twenty-first century. Nature 2008;451:919-28.

38. Kosarev VV, Babanov SA Pharmacotherapy of coronary heart disease: the focus cytoprotectors. Russkiy Meditsinskiy Zhurnal 2011; 19 (2): 1-4. In Russian (Косарев В.В., Бабанов С.А. Фармакотерапия ишемической болезни сердца: в фокусе цитопротекторы. Русский Медицинский Журнал 2011;19(2):1-4).

39. Zaitsev VI, Davydova IV Potashev SW. The experience of clinical application of trimetazidine in patients with essential hypertension and heart rhythm disturbances. Ukrainian Cardiology Journal 2008; 1: 105-9. In Russian (Зайцева В.И., Давыдова И.В., Поташев С.В. Опыт клинического применения триметазидина у больных с эссенциальной гипертензией и нарушениями сердечного ритма. Український кардіологічний журнал 2008.; 1: 105-9).

40. Kosarev VV, Babanov SA Clinical pharmacology of drugs used in cardiovascular diseases. Samara: Ofort; 2010. In Russian (Косарев В.В., Бабанов С.А. Клиническая фармакология лекарственных средств, применяемых при сердечно-сосудистых заболеваниях. Самара: Офорт; 2010).

41. Kosarev VV, Babanov SA Pharmacotherapy of coronary heart disease: the focus - cytoprotectors. Kardionevrologiya 2012; 1 (157): 60-5. In Russian (Косарев В.В., Бабанов С.А. Фармакотерапия ишемической болезни сердца: в фокусе – цитопротекторы. Кардионеврология 2012; 1(157): 60-5).

42. Kuznetsov VI, Chorbinskaya SA, Vyalov SS, et al. Angiozil® retard in the treatment and prevention of arrhythmias. Effektivnaya Farmakoterapiya v Kardiologii i Angiologii 2008; 2: 6-11. In Russian (Кузнецов В.И., Чорбинская С.А., Вялов С.С., и др. Ангиозил® ретард в лечении и профилактике аритмий. Эффективная Фармакотерапия в Кардиологии и Ангиологии 2008; 2: 6-11).

43. Xu X, Zhang W, Zhou Y et al. Effect of TMZ on Recurrent Angina Pectoris and Left Ventricular Structure in Elderly Multivessel Coronary Heart Disease Patients with Diabetes Mellitus After Drug-Eluting Stent Implantation: A Single-Centre, Prospective, Randomized, Double-Blind Study at 2-Year Follow-Up. Clinical Drug Investigation 2014; 34(4):251-8.

44. AkgüllüÇ., Saruhan T., Eryilmaz U., et al. The first histopathological evidence of trimetazidine for the prevention of contrast-induced nephropathy. Ren Fail 2014;36(4):575-80.

45. Chen J., Zhou S., Jin J., et al. Chronic treatment with trimetazidine after discharge reduces the incidence of restenosis in patients who received coronary stent implantation: a 1-year prospective followup study. Int J Cardiol 2014;174(3):634-9.

46. Tallarico D., Rizzo V., di Maio F., et al. Myocardial Cytoprotection by Trimetazidine Against Anthracycline-Induced Cardiotoxicity in Anticancer Chemotherapy. Angiology 2003; 54: 219-27.

47. Martsevich SY, Kutishenko NP, Ginzburg ML, et al. The KARDIOKANON Study: a way to address the issue of clinical equivalence of original and generic drugs. Ration Pharmacother Cardiol 2012; 8 (2) 179-84. In Russian (Марцевич С.Ю., КутишенкоН.П., Гинзбург М.Л., и др. Исследование КАРДИОКАНОН: способ решения вопроса о клинической эквивалентности оригинальных и воспроизведенных препаратов. Рациональная Фармакотерапия в Кардиологии 2012; 8(2); 179-84).

48. Shostak NA, Smolenskaya OG, Panov AV, et al. Possibilities of therapeutic cardiac cytoprotection in the treatment of complex coronary artery disease. Rossiyskiy Kardiologicheskiy Zhurnal 2009; 6: 25-8. In Russian. (Шостак Н.А., Смоленская О.Г., Панов А.В., и др. Возможности терапевтической кардиоцитопротекции в комплексно терапии ИБС. Российский Кардиологический Журнал 2009;6:25-8).

49. Afanasiev V.V. Trimetazidine. New to old (or what should be done to the drug worked, as you want). Symposium: The ambiguity of cardiovascular manifestations in patients receiving therapeutic conditions. XIII Congress of Physicians of the Northwestern Federal District. 12-13 March 2014; Saint-Petersburg. Available at: Retrieved 08/20/2015. In Russian. (Афанасьев В.В. Триметазидин. Новое о старом (или что нужно сделать, чтобы препарат работал, так как вам хочется). Симпозиум: Многозначность сосудистых проявлений у больных в условиях терапевтического приёма. XIII конгресс терапевтов СЗФО. 12-13 марта 2014; Санкт-Петербург. Доступно на: Проверено 20.08.2015).

50. Towler D. A. Molecular and Cellular Aspects of Calcific Aortic Valve Disease. Circ Res 2013; 113(2): 198-208.

51. Rashedi N., Otto C.M. Aortic Stenosis: Changing Disease Concepts. J Cardiovasc Ultrasound 2015;23(2):59-69.


For citations:

Karpova N.Yu., Rashid M.A., Shostak N.A., Pogonchenkova I.V., Kazakova T.V. PROSPECTS FOR CYTOPROTECTORS USE IN THE ELDERLY PATIENTS THROUGH THE EXAMPLE OF CALCIFIED AORTIC STENOSIS AND ISCHEMIC HEART DISEASE. Rational Pharmacotherapy in Cardiology. 2015;11(4):431-437. (In Russ.)

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