Rational Pharmacotherapy in Cardiology

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Vol 9, No 1 (2013)
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4-14 698

Aim. To estimate risk factors and comorbidity structure, cardiovascular diseases outcomes, evaluate their diagnostics and treatment quality in real outpatient practice using a register of patients with arterial hypertension (HT), ischemic heart disease (IHD), chronic heart failure (CHF) and atrial fibrillation (AF) in the Ryazan Region – the territorial subject ofRussian Federation with high cardiovascular mortality rate.

Material and methods. The total of 1000 HT, IHD, CHF, AF patients, applied for general practitioners or cardiologists of theRyazan outpatient clinics in March-May of 2012 were sequentially enrolled in the outpatient REgister of CardioVAscular diseases (RECVASA).

Results. According to outpatient cards data HT, IHD, CHF and AF were diagnosed in 99.0%; 70.9%; 74.8% and 13.7% of the 1000 cases, respectively. 820 (82%) patients revealed a concomitant cardiovascular pathology (cardiac comorbidity), at that the most frequent was combination of HT with IHD and CHF (50.4%). Diabetes mellitus was diagnosed in 209 (20.9%) patients. 770 (77%) patients were assessed on their total cholesterol level; smoking status and family history of heart diseases were estimated in 28 (2.8%) and 49 (4.9%) patients, respectively. Exercise tolerance test (stress-test) was carried out in 2% of the patients (including 2.8% of the IHD patients), 24-hour blood pressure (BP) and ECG monitoring – in 0.7% and 5.5%, respectively; echocardiography and ultrasound of brachiocephalic arteries (BCA) – in 25.6% and 8.6%, respectively; coronary angiography – in 1.6% (which includes 2.3% of the IHD patients). The following drug groups were prescribed most frequently: antiplatelet agents – in 60.4% of the cases (584 patients received acetylsalicylic acid and 20 – clopidogrel), ACE inhibitors – in 62.9%, β-blockers – in 43.9% of the patients. Target BP level was achieved in 245 of 956 cases (25.6%). 50.6% of IHD patients and 51.1% of hypercholesterolemic patients received statins.

Conclusion. The pilot stage of the RECVASA study revealed a high incidence rate of cardiac comorbidity (82%) in patients with hypertension, IHD, CHF and AF, insufficient estimation of cardiovascular risk factors, inadequate frequency of stress-tests, 24-hour BP and ECG monitoring, echocardiography, BCA sonography, coronary angiography use, as well as a scarce prescription of warfarin in AF and statins in hypercholesterolemic patients. Improvement of correspondence to national guidelines is the main reserve for enhancement of diagnostics and treatment quality in patients with HT, IHD, CHF, AF and hypercholesterolemia.

15-24 761

Aim. To identify risk factors of decompensation of chronic heart failure (CHF) and related hospitalization in elderly outpatients.

Material and methods. The total of 248 patients aged 60–85 years with CHF NYHA class II-IV were enrolled into the study. The first group consisted of 87 (35.1%) patients who required hospitalization due to CHF decompensation during the follow-up, the second group of 161 patients without need for hospital admission. All the patients had undergone clinical and laboratory examination, estimation of CHF severity by the Scale of clinical state, assessment of quality of life and 6-minute walk test (6MWT), echocardiography.

Results. Patients were matched for age, gender, disability occurrence, education level, body mass index, quality of life, hemodynamic parameters, incidence rates of anemia, diabetes mellitus and atrial fibrillation. CHF was more severe in patients who had required hospitalization (p<0.001), they were more often diagnosed with left ventricular aneurysm (p=0.001), chronic kidney disease (p=0.001), left ventricular ejection fraction (LVEF)<35% (p<0.001), history of stroke (p<0.001), III-IV degree mitral regurgitation (p=0.007), hyperuricemia (p<0.001), lower exercise tolerance (p=0.007) compared with patients without hospitalization. Higher functional class of CHF (OR=0.29; 95% CI 0.13–0.69; p=0.003), LVEF<35% (OR 0.37; 95% CI 0.18–0.76; p=0.007), chronic kidney disease (OR=0.29; 95% CI 0.13–0.68; p=0.004) and hyperuricemia (OR=0.23; 95%CI 0.10–0.50; p<0.001) were shown to be independent risk factors of CHF decompensation that required hospital admission in elderly patients.

Conclusuion. High FC of CHF, low LVEF, hyperuricemia and renal dysfunction play a key role in CHF decompensation and related hospitalization in elderly patients.

25-30 1328

Aim. To assess the effect of meldonium (in combination with antihypertensive therapy) on the severity of asthenic syndrome (AS) in elderly patients with arterial hypertension (HT).

Material and methods. Patients (n=180, >65 years old) with HT (grade 1–2) and secondary somatogenic AS (assessed by the MFI-20 scale). The patients were randomized into 3 groups according to the scheme of treatment. Group 1 — intermittent treatment with meldonium (500 mg once daily for 3 months followed by a break 3 months; 2 courses). Group 2 — continuous treatment with meldonium (500 mg once daily for 12 months). Group 3 — control (receive only antihypertensive drugs). Evaluation of AS was assessed by MFI-20 scales at baseline and at week 52 of treatment.

Results. AS signs attenuation was found in groups 1 and2. In group1 a number of patients with general asthenia decreased on 70.5% (p<0.05), with physical asthenia — on 47.7% (p<0.05), with reduced activity — on 33.3%, reduced motivation — on 25%. In group2 a number of patients with general asthenia decreased on 60% (p<0.05), physical asthenia — on 39.7%, reduced activity — on 79.9% (p<0.05), reduced motivation — on 12.2%, mental asthenia — on 77.7% (p<0.05). In group 3 no significant changes in these parameters were found. Moreover a number of patients with mental asthenia increased on 45.4% (p<0.05).

Conclusion. Meldonium included into antihypertensive therapy can reduce the symptoms of secondary somatogenic AS. More pronounced antiasthenic effect can be achieved with meldonium taking regime 500 mg daily continuously for 52 weeks.

31-34 527

Aim. To evaluate the functional activity of platelets by the optical standard aggregatometry and induced flow cytofluorometry during antiplatelet therapy with clopidogrel and acetylsalicylic acid (ASA).

Material and methods. The evaluation of platelet function in 30 patients with ischemic heart disease treated with dual antiplatelet therapy (ASA and clopidogrel) was performed by two methods: the standard photometric method with the assessment of degree of light transmission at the maximum point and by the original method of induced flow cytofluorometry with the platelet activity evaluation by changing of glycoprotein (GP) IIb/IIIa receptor level and the expression of P-selectin before and after ADP induction.

Results. Increase in platelet functional activity was detected in patients with ASA monotherapy at initial evaluation by both induced flow cytofluorometry and standard photometric method. After one month dual antiplatelet therapy platelet function significantly decreased according to standard photometric method (from 61.4Ѓ}3.6 to 45.9Ѓ}3.7; p<0.05; the induction of 2.5 mM ADP), as well as according to flow cytofluorometry with changing of GP IIb/IIIa receptor level (from 12.2Ѓ}0.8% to 5.2Ѓ}0.8%; p<0.05) and the expression of P-selectin (from 70.5Ѓ}5.9% to 57.4Ѓ}5.9%; p<0.05).

Conclusion. The combined use of laboratory methods to assess platelet function (traditional and high-tech) provides cardiologist with additional tool for assessing the effectiveness of antiplatelet therapy in patients with ischemic heart disease.

35-39 552

Aim. To access the role of endothelial adhesive dysfunction in the development of atrial fibrillation (AF) in patients with ischemic heart disease (IHD) complicated by chronic heart failure (CHF).

Material and methods. 111 patients with CHF class I–IV due to myocardial ischemia were included in the study. All participants were divided into four groups according to the presence of AF and CHF class. The control group consisted of 25 healthy individuals. Endothelial adhesive function was assessed by levels of soluble intercellular adhesive molecules sVCAM-1 and sE-selectin.

Results. The sVCAM-1 level in patients with CHF class III–IV with AF was significantly higher than this in control group and patients with CHF class I–II regardless of AF occurrence, as well as higher than this in patients with CHF class III–IV without AF (65%, 56.1%, 36.3% and 13.9%, respectively, p<0.05). Direct correlations between sVCAM-1 level and the left atrium volume index (LAVI) (r=0.52; p<0.05) and between sE-selectin level and LAVI (r=0.48; p<0.05) were revealed.

Conclusion. Endothelial adhesive dysfunction associates with AF existence and the severity of CHF.

40-43 716

Aim. To identify the structural and functional heart parameters in patients with chronic heart failure (CHF) depending on severity of endogenous intoxication syndrome that is defined by blood middle mass molecules (MMM) level.

Material and methods. In 110 patients with CHF standard clinical, laboratory and instrumental (echocardiography) examinations were performed. Besides the blood MMM levels were determined in all patients. The patients were divided into three groups with minimal, moderate and severe endogenous intoxication depending on MMM levels.

Results. 41.8% of patients had the minimal severity of endogenous intoxication, 39.1% average degree and 19.1% severe intoxication. The patients with the highest MMM levels were specified by low left ventricular ejection fraction (p<0.05), the largest size of right ventricle, the lowest rate of preserved left ventricular function and high rate of diagnosis of increased sizes of the left atrium, interventricular septum and right ventricle.

Conclusion. The MMM level can serve as a criterion for prognosis of CHF. Patients with high blood MMM level have the worst prognosis.

44-47 535

Aim. To evaluate the rate of left ventricular hypertrophy (LVH) and left ventricular (LV) geometry types in ischemic heart disease (IHD) among men of working age in one of the mountain regions of Azerbaijan.

Material and methods. A representative sample of the informal working age men population living in the foothills and midlands of theRepublic ofAzerbaijan was examined. Representative sample was formed by the method of random numbers. Strictly standardized survey methods and evaluation criteria recommended by WHO for epidemiological studies were used. Echocardiography with evaluation of the heart morphological parameters was performed in all the subjects.

Results. The prevalence of LVH in IHD patients was 68.8% [based on the calculation ofLV mass (LVM) and the LVM index (LVMI)]. The most reliable LVH detection was observed with calculation of three indexes LVMI, LVMI/height and LVM/height2,7. The least reliable LVH detection was observed with use only one index LVM/ height2,7. Normal LV geometry was registered in 20 (21.5%) patients with IHD,LV concentric remodeling in 18 (19.4%), concentric LVH in 23 (24.7%), and eccentric LVH in 32 (34.4%) patients.

Conclusion. The results of the study show significant prevalence of both LVH and adverse types ofLV remodeling in this population. This calls for further research to study the causes of revealed epidemiological situation.

48-55 614

Aim. To study clinical and cost effectiveness of training of young patients with arterial hypertension (HT) in the health school in comparison with individual counseling.

Material and methods. Hypertensive outpatients (n=114) at the age of 18-27 years were included into the study. Patients were randomized into 2 groups: “Health school” and "Typical practice". “Health school” patients received special training course “School health for patients with HT." Patients of the "Typical practice" had individual consultation. Clinical and cost analysis was performed in 6, 12 and 36 months of the follow-up.

Results. The total cardiovascular risk in patients of “Health school” and "Typical practice" groups after 12 months decreased from 15.85Ѓ}3.47% to 7.22Ѓ}2.59% and from 15.60Ѓ}3.34% to 11.29Ѓ}4.14%, respectively, after 36 months to 10.77Ѓ}3.18% and to 11.40Ѓ}3.93%, respectively. Cost of 1% reduction in the total cardiovascular risk was 3425.1 and 190.4 rubles per one patient in “Health school” and "Typical practice" groups, respectively.

Conclusion. The more time after the training course passes, the more its clinical and cost effectiveness reduces. This requires a follow-up care and repeated preventive counseling of these patients.


56-61 630

Antiarrhythmic effect of omega-3 polyunsaturated fatty acids (ω-3 PUFA), eicosapentaenoic and docosahexaenoic acids in patients with recurrent atrial fibrillation and ventricular arrhythmias had been proven. The positive effect of the ω-3 PUFA on the risk of sudden arrhythmic death and overall mortality in the patients after myocardial infarction and patients with chronic heart failure had been also proven.

62-65 725

The mechanism of myocardial damage in diabetes mellitus is considered. The pathogenesis of myocardial fibrosis, leading to diabetic cardiomyopathy, is described in details. Management tactics aimed at the prevention of heart failure in patients with diabetes is proposed.

66-73 664

The article reviews the pharmacoepidemiological and pharmacoeconomic trials of antihypertensive therapy, conducted during the last decades inRussia. Despite the increased interest to the issue of cost-effectiveness of arterial hypertension treatment in recent years, in most cases researches carried out in this area are characterized by the using of simple methods of pharmacoeconomic analysis, taking into account only the direct costs, as well as determining of the drugs cost-effectiveness in clinical trials, and not in real clinical practice.

74-78 503

Diabetes mellitus (DM) is one of the health and social problems of modern health care. The main causes of death in patients with DM are macrovascular complications. Intensive hypoglycemic therapy is recommended to prevent complications; however it can increase the risk of severe hypoglycemia with subsequent growth rate of mortality. Glucose blood levels should be monitored to reduce the risk of cardiovascular disease and death, as well as control of normoglycemia and risk factors are needed. DM pathogenesis and prevalence are considered, and effects of glucose blood level on its outcomes are analyzed.


79-85 1342

Classification, modes of action and clinical effects of calcium channel blockers are presented. Advantages of the third generation of dihydropyridine calcium channel blockers are considered. Clinical pharmacology, studies on the efficacy, safety and prevention of hypertensive complications with lercanidipine are detailed.

86-89 573
Findings of the main clinical trials of amlodipine in the treatment of arterial hypertension and prevention of fatal and non-fatal cardiovascular events are presented.
90-98 617

Translation articles: B.A. Ference, W. Yoo, I. Alesh, N. Mahajan, K.K. Mirowska, A. Mewada, J. Kahn, L. Afonso, K.A. Williams, J.M. Flack «Effect of Long-Term Exposure to Lower Low-Density Lipoprotein Cholesterol Beginning Early in Life on the Risk of Coronary Heart Disease. A Mendelian Randomization Analysis» впервые опубликована в журнале J Am Coll Cardiol 2012; 60(25): 2631-9;

doi:10.1016/j.jacc.2012.09.017 © 2012 by the AmericanCollegeofCardiology Foundation


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