Aim. To study the role of immune inflammatory reactions and endothelial dysfunction in myocardial remodeling and progression of ischemic heart disease (IHD).

Material and methods. 413 patients with IHD including 251 patients with stable and 162 patients with unstable angina were enrolled into the study. 55 healthy subjects were included into control group. Myocardial remodeling was studied by echocardiography. Immune inflammatory reactions were studied by detection of primary and secondary products of lipid peroxidation and antioxidative enzymes, pro- and antiinflammatory cytokines. Endothelial function was assessed by endothelium-dependent vasodilatation (EDVD) and levels of endothelin-1 (ET-1) and adhesion molecules.

Results. Correlation analysis showed relations of indicators of lipid peroxidation and antioxidative enzymes with proinflammatory cytokines – interleukin-1β, interleukin-6, tumor necrosis factor-alpha (TGF-α) (r=-0.39; -0.54; -0.42, respectively; р<0.05) and EDVD, ET-1 and E-selectin (r=-0.44; 0.52; 0.49, respectively; р<0.05). Interrelations of lipid peroxidation products and glutathione peroxidase with hemodynamic parameters were found out, as well as between TGF-αconcentration and indicators of myocardial remodeling. Strong correlations were revealed between parameters of endothelial and myocardial functions.

Conclusion. The role of immune inflammatory reactions and endothelial dysfunction in myocardial remodeling and IHD progression was established on the basis of the correlation analysis.

Aim. To study the efficacy of loop diuretic torasemide compared with furosemide consisting of combination therapy in patients with chronic heart failure (CHF).

Material and methods. Inpatient and outpatient patients (n=136; 80 men and 56 women) with CHF class 2-3 (NYHA) living in different regions of Kazakhstan were included into the study.

Results. More pronounced decrease in edema syndrome, significant decrease in the rate of maladaptive myocardial remodeling, increase in systolic function by 8.2%, improving quality of life by 30.1% took place during combination therapy including loop diuretic torasemide compared with furosemide.

Conclusion. The loop diuretic torasemide consisting of combination therapy has a positive effect on myocardial remodeling and improves quality of life in patients with CHF class 2-3 (NYHA).

Aim. To evaluate an adequacy of dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome (ACS) with ST segment elevation and bare metal stent implantation after hospital discharge.

Material and methods. 311 patients with ACS with ST segment elevation were included into the study. All of them underwent percutaneous coronary intervention with bare metal stent implantation. The information was obtained by the telephone survey.

Results. 54.5% of patients received DAPT during 12 months. 43.8% of patients also received combination of clopidogrel and acetylsalicylic acid, but changed medicinal products of clopidogrel due to different reasons. 1.7% of patients received acetylsalicylic acid only.

Conclusion. More than 50% of patients received recommended DAPT at that they preferred generic drugs of clopidogrel original one.

Clinical case study is described. Patient D, 55 years old, applied to the Lipid clinic of State Research Centre for Preventive Medicine because of low blood cholesterol level. Results of the differential diagnosis of the hypocholesterolemia syndrome by using exomic sequencing are presented. This method allows to sequence the majority of regions of genome containing exons, protein-coding parts of genes. Heterozygous mutation in the gene for APOB (5 nucleotides deletion) was found out in the patient by using exomic sequencing. This mutation leads to a premature stop codon with violation of apolipoprotein B-100 synthesis and causes inherited monogenic disease - family hypobetalipoproteinemia.

Statins, the most common drugs for reduction in lipid levels, are “strategic” medicinal products for the treatment and prevention of cardiovascular diseases caused by atherosclerosis. The milestones of lipid-lowering therapy history are presented as well as its contemporary aims and their implementation with focus on rosuvastatin. Data of recent metaanalysis regarding statins efficacy in primary and secondary prevention of cardiovascular complications, good safety and tolerability profile were presented. Treatment of patients with acute coronary syndrome with modern statins in high doses is discussed specially. Clinical case study of long-term treatment with rosuvastatin 20 mg/day is described. Frequency of statin prescriptions and achievements of target lipid levels in real medical practice among population of Russian patients is evaluated according to results of LIS study and PROFILE registry. Results of Russian studies of therapeutic equivalence of generic drug with original rosuvastatin are presented.

Aim. To study the efficacy of rosuvastatin in dyslipidemia correction in patients after Q-wave myocardial infarction (Q-MI).

Material and methods. 40 patients (aged 52.7±9.4 years old) were included into the study after 10-14 days of the acute Q-MI onset. Determination of blood lipids profile, alanine and asparagine transaminase levels was included into the initial examination. Rosuvastatin in a fixed dose of 20 mg/day was prescribed to the patients as a part of the standard therapy. Depending on the dynamics of the investigated parameters the individual doses of rosuvastatin were adjusted from 10 to 40 mg/day after 1 month of therapy. Final evaluation of blood lipids profile and transaminase levels was performed in the next 2 months of therapy.

Results. Rosuvastatin 20 mg/day for 1 month in patients with an acute Q-MI provides a significant decrease in low-density lipoprotein (LDL) cholesterol level by 21.4%, and achievement of target levels of this parameter in 59.5% of patients. Rosuvastatin dose adjustment was required in 48.6% of patients after 1 month of therapy. Individually adjusted rosuvastatin doses provided the achievement of LDL cholesterol target levels by the end of the third month of treatment in 91% of patients. Elevated liver transaminase levels were observed in 7.5% of patients after 1 month of treatment. There were no new cases of adverse events after 3 months of therapy.

Conclusion. Rosuvastatin 10-40 mg/day is effective and safe medicine for the treatment of dyslipidemia in patients after acute Q-MI.

News from Congress of the European Society of Cardiology (Barcelona, 2014) is highlighted. Results of recent controlled clinical trials, new clinical recommendations and registers data that were presented at the Congress are discussed.

Aim. To evaluate the association of serum resistin with morphological and functional indices of hypertrophic myocardium in patients with type 2 diabetes and chronic heart failure (CHF) with preserved left ventricular ejection fraction.

Material and methods. Patients (n=60; 12 men and 48 women) with type 2 diabetes and ischemic heart disease and CHF class II-III (NYHA) were included into the study. Clinical, laboratory and instrumental examinations, as well as determination of serum resistin were performed in all patients.

Results. Positive correlation was found between serum resistin level and left ventricle end-diastolic pressure (LV EDP; r=0.43; p=0.02) in patients with concentric left ventricular hypertrophy (LVH). Negative correlation was found between serum resistin level and LV EDP (r=-0.61; p=0.000) in patients with eccentric LVH. A number of supraventricular extrasystoles positively correlated with the serum resistin level (r=0.34; p=0.033) in patients with concentric LVH.

Conclusion. The role of "physiological" levels of resistin in the formation of cardiovascular indicators of the hypertrophic myocardium as well as possible prognostic significance of different levels of resistin for optimization of therapy are shown in patients with type 2 diabetes with CHF.

Approaches to the total cardiovascular risk calculation based on the actual clinical recommendations are presented as well as the application of risk categories for the choice of strategy of dyslipidemia correction. The use of statins as lipid-lowering therapy in patients with acute coronary syndrome and coronary angioplasty are also discussed.

Optimization of pharmacotherapy in the preoperative period is the cornerstone of the risk modification of cardiovascular complications in the perioperative period. Particular attention has recently been focused on statins use. Evidence base of this drugs class use in the perioperative period serves as the basis for the development of clinical guidelines. However, the results of large randomized trials of statins are controversial. Ambiguous interpretations of these trials data has resulted in significant differences in the classes of recommendations and levels of evidence. Analysis of results of the basic clinical trials and the guidelines of international and national medical societies on the use of statins in patients with cardiovascular diseases to reduce the risk of cardiac complications in the perioperative period in planned extracardiac surgery is presented.

History of thrombolytic therapy is shortly reflected, main trials of various thrombolytics in acute ST-segment elevation myocardial infarction (STEMI) are analyzed. Perspectives of modern thrombolytic therapy in patients with STEMI are discussed.

Results of clinical trials devoted to urapidil, antihypertensive drug having central and peripheral mode of actions are reviewed. Target groups of patients for urapidil use are specified. Dosage regimen and methods of urapidil use in different clinical situations with acute increase in arterial blood pressure are described in details.

Rationale and benefits of the use of the ACE inhibitor lisinopril in the clinical practice as an antihypertensive drug are considered. Special attention is paid to the organ protective effects of lisinopril and its application in some clinical situations (combination of hypertension with chronic obstructive pulmonary disease, elderly patients, and concomitant liver diseases).

Vladimir G. Kukes is 80.

Information letter.