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Rational Pharmacotherapy in Cardiology

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Optimal Medical Therapy for Chronic Coronary Syndrome: Realities and Prospects

https://doi.org/10.20996/1819-6446-2021-06-17

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Abstract

Combination therapy is the standard of treatment for virtually all current non-communicable diseases, primarily chronic coronary heart disease, in modern terminology - "chronic coronary syndrome" (CSS), arterial hypertension, chronic heart failure, diabetes mellitus. The need for a combination of drugs increases even more with comorbidity, which is a typical situation in clinical practice. The recently accumulated material requires a review of the possibility of percutaneous coronary intervention and coronary bypass surgery in prolonging the life of patients with CCS, focusing on providing optimal medical therapy (OMT) for each patient with CCS, based on long-term treatment with antiplatelet agents, statins, angiotensin converting enzyme in-hibitors/angiotensin receptor blockers, beta-blockers. OMT aimed at preventing cardiovascular events and relieving symptoms in patients with CCS requires maximum commitment - a key factor in achieving therapeutic goals. Insufficient adherence of patients to prescribed therapy and its absence are the main barriers to increasing the survival rate of patients with cardiovascular diseases in primary and secondary prevention in the Russian Federation, as evidenced by numerous registers. The desire of the doctor to individualize treatment, which inevitably complicates the use of drugs, pushes patient adherence to treatment into the background. As a result, the patient's lack of commitment to each of the pharmaceuticals destroys the applicability of the OMT concept. A great achievement of the current stage of development of clinical cardiology and the pharmaceutical industry is the ability to offer patients optimal single pill combinations (SPC) in terms of effectiveness, tolerability, drug interactions, and ease of use. The article substantiates the prospects for a successful solution of this key problem by using a new generation of SPC components belonging to different pharmacological groups. The combination of three components (lisinopril, amlodipine and rosuvastatin), each of which has pleiotropic effects, provides a multi-targeted effect with a single dose, with the possibility of individualization of therapy, which is provided by four dosage options within this SPC.

About the Authors

P. A. Lebedev
Petr A. Lebedev - eLibrary SPIN 8085-3904
Russian Federation


I. K. Petrukhina
Irina K. Petrukhina - eLibrary SPIN 3642-4547
Russian Federation


A. A. Garanin
Andrei A. Garanin - eLibrary SPIN 9976-3085
Russian Federation


E. V. Paranina
Elena V Paranina - eLibrary SPIN 9256-8661
Russian Federation


References

1. Roth GA, Johnson C, Abajobir A, et al. Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015. J Am Coll Cardiol. 2017,70(1 ):1 -25. DOI:10.1016/j.jacc.2017.04.052.

2. Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J. 2020,41(3):407-77. DOI:10.1093/eur-heartj/ehz425.

3. Kontsevaya AV, Balanova YuA, Imaeva AE, et al. Economic burden of hypercholesterolemia in the Russian Federation. Rational Pharmacotherapy in Cardiology. 2018,1 4(3):393-401 (In Russ.) DOI:10.20996/1819-6446-2018-14-3-393-401.

4. Zagrebelny AV, Martsevich SYu, Lukyanov MM, et al. The quality of lipid-lowering therapy in outpatient practice: data from the REKVAZA register. Preventive Medicine. 2016,19(1):9-14 (In Russ.) DOI:10/17116/profmed20161919-14.

5. Bubnova MG, Aronov DM, Deev AD. Statin therapy in real clinical practice in elderly patients with hyperlipidemia and coronary heart disease. Russian program EFFORT. Atherosclerosis and Dyslipidemia. 2018,1(30),5-16 (In Russ.)

6. Ezhov MV, Lazareva NV, Sagaidak OV, et al. Frequency of lipid metabolism disorders and the use of statins in acute coronary syndrome (according to the Federal Register of Acute Coronary Syndrome). Atherosclerosis and Dyslipidemia. 2018,1(30):47-58 (In Russ.)

7. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020,41(1):111-188. DOI:10.1093/eurheartj/ehz455.

8. Jennings GL. A New Guideline on Treatment of Hypertension in Those with Coronary Artery Disease: Scientific Statement From the American Heart Association, American College of Cardiology, and American Society of Hypertension About Treatment of Hypertension in Patients with Coronary Artery Disease. Heart Lung Circ. 2015,24(1 1):1037-40. DOI:10.1016/j.hlc.2015.05.022.

9. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executivesummary: a report of the American College of Cardiology/American heart association task force on clinical practiceguidelines. Hypertension. 2018,71 (6):1269-324. DOI:10.1161/HYP.0000000000000066.

10. 2017 Committee for Human Medicinal Products (CHMP) Guideline on clinical development of fixed combination medicinal products [cited by May 20, 2020]. Available from: https://www.ema.eu-ropa.eu/en/documents/scientific-guideline/guideline-clinical-development-fixed-combination-medicinal-products-revision-2_en.pdf.

11. Gupta P, Patel P, Strauch B, et al. Risk factors for nonadherence to antihypertensive treatment. Hypertension 2017,69(6):1 1 13-20. DOI:10.1161/HYPERTENSIONAHA.116.08729.

12. Verma AA, Khuu W, Tadrous M, et al. Fixed-dose combination antihypertensive medications, adherence, and clinical outcomes: a population-based retrospective cohort study. PLoS Med. 2018,15(6):e1002584. DOI:10.1371/journal.pmed.1002584.

13. Kumagai N, Onishi K, Hoshino K, et al. Improving drug adherence using fixed combinations caused beneficial treatment outcomes and decreased health-care costs in patients with hypertension. Clin Exp Hypertens. 2013,35(5):355-60. DOI:10.3109/10641963.2012.732644.

14. Bansilal S, Castellano JM, Garrido E, et al. Assessing the impact of medication adherence on longterm cardiovascular outcomes. J Am Coll Cardiol. 2016,68:789-801. DOI: 10.1016/j.jacc.2016.06.005.

15. Weisser B, Predel HG, Gillessen A, et al. Single Pill Regimen Leads to Better Adherence and Clinical Outcome in Daily Practice in Patients Suffering from Hypertension and/or Dyslipidemia: Results of a Meta-Analysis. High Blood Press Cardiovasc Prev. 2020,27(2):1 57-64. DOI:10.1007/s40292-020-00370-5.

16. Webster R, Anushka P, Selak V, et al. Effectiveness of fixed dose combination medication ('polypills') compared with usual care in patients with cardiovascular disease or at high risk: A prospective,indi-vidual patient data meta-analysis of 3140 patients in six countries. Int J Cardiol. 2016,205:1 47-56. DOI:10.1016/j.ijcard.2015.12.015.

17. Morozova TE, Yudina IYu, Karnoukh KI, Shatskiy DA. Polypill in the prevention of cardiovascular diseases: evidence base, limitations and perspectives (based on the report of the European Society of Hypertension). Consilium Medicum. 2017,19(10):8-12 (In Russ.) DOI:10.26442/2075-1753_19.10.8-12.

18. Collet JP, Thiele H, Barbato E, et al. ESC Scientific Document Group. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021,42(14):1289-367. DOI:10.1093/eurheartj/ehaa575.

19. Maron DJ, Hochman JS, Reynolds HR, et al. ISCHEMIA Research Group. Initial Invasive or Conservative Strategy for Stable Coronary Disease. N Engl J Med. 2020,382(1 5):1395-407. DOI:10.1056/NE-JMoa1915922.

20. Lee SW, Lee PH, Ahn JM, et al. Randomized Trial Evaluating Percutaneous Coronary Intervention for the Treatment of Chronic Total Occlusion: The DECISION-CTO Trial. Circulation 2019,139(1 4):1674-83. DOI:10.1161/CIRCULATIONAHA.118.031313.

21. Crea F. Guidelines on myocardial infarction, novel therapeutic targets in post-infarction remodelling, and a debateon the ISCHEMIA trial. Eur Heart J. 2021,42(1 4):1277-80. DOI:10.1093/eurheartj/ehab173.

22. Winther S, Schmidt SE, Rasmussen LD, et al. Validation of the European Society of Cardiology pretest probability model for obstructive coronary artery disease. Eur Heart J. 2021,42(14):1401 -1 1. DOI:10.1093/eurheartj/ehaa755.

23. Panov AV, Abesadze IT, Alugishvili MZ, et al. Register of patients with stable coronary artery disease underwent coronary artery bypass grafting surgery (RICOCHET program). Arterial Hypertension. 2014,20(6):568-77 (In Russ.) DOI:10.18705/1607-419X-2014-20-6-568-577.

24. Bhatt DL, Steg PG, Ohman EM, et al. Reach registry investigators: international prevalence, recognition and treatment of cardiovascular risk factors in outpatients with atherotrombosis. JAMA. 2006,295(2):1 80-9. DOI:10.1001/jama.295.2.180.

25. Аndres E, Cordero A, Magan P, et al. Long-term mortality and hospital readmission after acute my-ocardials infarction:an eight-year follow-up study. Rev Esp Cardiol (Engl Ed). 2012,65(5):414-20. DOI:10.1016/j.recesp.2011.09.009.

26. Davidovich IM, Malay LN, Kutishenko NP. The analysis of long-term outcomes and adherent to treatment in patients after myocardial infarction: Khabarovsk register data. The Clinician. 2017,11(1):36-44 (In Russ.) DOI:10.17650/1818-8338-2016-1 0-4-36-44.

27. Korhonen MJ, Robinson JG, Annis IE, et al. Adherence Tradeoff to Multiple Preventive Therapies and All-Cause Mortality After Acute Myocardial Infarction. J Am Coll Cardiol. 2017,70(13):1 543-54. DOI:10.1016/j.jacc.2017.07.783.

28. Gioudhry NK, Avorn J, Glynn RJ, et al. Full coverage for preventivemedications after myocardial infarction. N Engl J Med. 2011,365(22):2088-97. DOI:10.1056/NEJMsa1107913.

29. Choudhry NK, Glynn RJ, Avorn J, et al. Untangling the relationship between medication adherence and post-myocardial infarction outcomes: medication adherence and clinical outcomes. Am Heart J. 2014,1 67(1):51 -58.e5. DOI:10.1016/j.ahj.2013.09.014.

30. DondoTB, Hall M, West RM,et al. p-Blockers and Mortality After Acute Myocardial Infarction in Patients Without Heart Failure or Ventricular Dysfunction.J Am Coll Cardiol. 2017,69(22):271 0-20. DOI:10.1016/j.jacc.2017.03.578.

31. Soldati S, Di Martino M, Castagno D, et al. In-hospital myocardial infarction and adherence to evidence-based drug therapies: a real- world evaluation. BMJ Open. 2021 ,11 (2) :e042 878. DOI:10.1136/bmjopen-2020-042878.

32. Puchin'yan NF, Dovgalevskiy YaP, Dolotovskaya PV, Furman NV The adherence to recommended therapy in patients after acute coronary syndrome, and risk of cardiovascular complications within a year after hospital admission. Rational Pharmacotherapy in Cardiology. 2011,7(5):567-73 (In Russ.) DOI:

33. Khaisheva LA, Glova SE, Suroedov VA, et al. Evaluation of Drug Therapy and Adherence to It in Patients after Acute Coronary Syndrome in Real Clinical Practice (Results of One Year Observation). Rational Pharmacotherapy in Cardiology 2018,14(6):852-7 (In Russ.) DOI:10.20996/1819-6446-2018-14-6-852-857.

34. Steg PG, Ducrocq G. Future of the Prevention and Treatment of Coronary Artery Disease. Circ J. 2016,80(5):1067-72. DOI:10.1253/circj.CJ-16-0266.

35. Ridker PM, Luscher TF Anti-inflammatory therapies for cardiovascular disease. Eur Heart J. 2014,35(27):1 782-91. DOI:10.1093/eurheartj/ehu203.

36. Koushki K, Shahbaz SK, Mashayekhi K, et al. Anti-inflammatory Action of Statins in Cardiovascular Disease: the Role of Inflammasome and Toll-Like Receptor Pathways. Clin Rev Allergy Immunol. 2021,60(2):1 75-1 99. DOI:10.1007/s12016-020-08791-9.

37. Zhu J, Wu S, Hu S, et al. NLRP3 inflammasome expression in peripheral blood monocytes of coronary heart disease patients and its modulation by rosuvastatin. Mol Med Rep. 2019,20(2):1 826-36. DOI:10.3892/mmr.2019.10382.

38. Duewell P, Kono H, Rayner KJ, et al. NLRP3 inflammasomes are required for atherogenesis and activated by cholesterol crystals. Nature. 2010,464(7293):1357-61. DOI:10.1038/nature08938.

39. Thondapu V, Kurihara O, Yonetsu T, et al. Comparison of Rosuvastatin Versus Atorvastatin for Coronary Plaque Stabilization. Am J Cardiol. 2019,1 23(1 0):1 565-71. DOI:10.1016/j.amjcard.2019.02.019.

40. Jones PH, Davidson MH, Stein EA, et al. STELLAR Study Group. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR* Trial). Am J Cardiol. 2003,92(2):1 52-60. DOI:10.1016/s0002-9149(03)00530-7.

41. Wang YC, Hsieh TC, Chou CL, et al. Risks of adverse events following coprescription of statins and calcium channel blockers: A nationwide population-based study Medicine (United States). 2016,95(2):e2487. DOI:10.1097/MD.0000000000002487.

42. Nissen SE, Tuzcu EM, Libby P, et al. CAMELOT Investigators. Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure: the CAMELOT study: a randomized controlled trial. JAMA. 2004,292(1 8):221 7-25. DOI:10.1001/jama.292.18.221 7.

43. The top 300 drugs of 2021 provided by the ClinCalc drugstats Database [cited by May 20, 2020]. Available from: https://clincalc.com/DrugStats/Top300Drugs.aspx.

44. Karpov YuA. Triple combination of antihypertensive and lipid-lowering drugs - effective reduction of the risk of cardiovascular complications in patients with arterial hypertension. Russian Medical Journal. 2015,27:1 580-83 (In Russ.)

45. Blankova ZN, Aslanyan NS. The effect of combined therapy on the properties of the vessel wall in patients at high risk of cardiovascular complications. Systemic Hypertension. 2017,14(2):51-5 (In Russ.)

46. Nedogoda SV, Chumachek EV, Ledyaeva AA, et al. Optimal organoprotection, control of blood pressure and metabolic disorder with the fixed combination of lisinopril, amlodipine and rosuvastatin in systemic hypertension. Russian Journal of Cardiology. 2018,(4):49-55 (In Russ.) DOI:10.15829/1560407120184.


For citation:


Lebedev P.A., Petrukhina I.K., Garanin A.A., Paranina E.V. Optimal Medical Therapy for Chronic Coronary Syndrome: Realities and Prospects. Rational Pharmacotherapy in Cardiology. 2021;17(3):498-506. (In Russ.) https://doi.org/10.20996/1819-6446-2021-06-17

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ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)