Rational Pharmacotherapy in Cardiology

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Vol 11, No 4 (2015)
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355-358 676

Aspects of comorbidity in patients with chronic heart failure are discussed. A focus on hyperuricemia, its effect on the course and prognosis in patients with heart failure, as well as the possibility of its medical correction are maintained.

371-379 657

Aim. To study the possibilities of using multi-channel volume sphygmography (MCVS) in prophylactic medical examination of the population.

Material and methods. Simultaneous examination of 522 individuals older than 18 years was performed. Along with standard procedures provided by the prophylactic medical examination program synchronous registration of blood pressure (BP) on four extremities by MCVS was performed. At that a difference in systolic BP between arms (ΔSBParm) and legs (ΔSBPleg) and ankle-brachial index (ABI) were automatically calculated. Values of │ΔSBParm│ or │ΔSBPleg│≥15 mm Hg or ABI≤0.9 were considered as markers of atherosclerotic vascular disease.

Results. Signs of peripheral arterial atherosclerotic lesions among patients ≥40 years old were found in 14.7% of the cases (95% confidence interval [CI] 11.7-18.4). Relative risks of atherosclerotic lesions in arteries increase 1.71-fold (95% CI 1.06-2.74) in arterial hypertension, 1.70-fold (95% CI 1.08-2.68) – in obesity, 1.91 fold (95% CI 1.17-3.12) – in diabetes, as well as with the increasing levels of cardiovascular risk. In patients with ischemic heart disease and a history of cerebral stroke MCVS can detect signs of multifocal atherosclerosis in 21% (95% CI 14-32) and 22% (95% CI 9-46) of the cases, respectively.

Conclusion. MCVS with the determination of ΔSBParm, ΔSBPleg and ABI may be regarded as the basis for low-cost and efficient system of cardioangiological screening.


380-384 738

Cardiovascular diseases remain the most common cause of death in Russia. In real clinical practice doctors are more focused on the modification of other major risk factors rather than on the correction of dyslipidemia, or pay more attention to secondary prevention of cardiovascular diseases.

Aim. To analyze the incidence of severe dyslipidemia (total cholesterol >9 mmol/l), clinical signs of atherosclerosis at its presence and the adequacy of hypolipidemic treatment according to the data of multi-field medical hospital.

Material and methods. We have analyzed 28225 medical charts of patients undergoing treatment in Therapeutic Departments of Petrozavodsk urgent care hospital for the years from 2001 to 2012.

Results. The incidence of severe dyslipidemia (total cholesterol >9 mmol/l) was 1.59%. The most frequent nonlipid risk factor for ischemic heart disease was arterial hypertension (was diagnosed in 85% of patients). The main clinical manifestation of atherosclerosis was ischemic heart disease (it was diagnosed in 79.3%), 48.9% of patients had a history of acute myocardial infarction, 28.9% - of stroke. In patients with severe dyslipidemia (total cholesterol >9 mmol/l) the frequency of statins prescription in 2009-2012 was 70%. In 28.9% of the patients the target levels of total cholesterol and low-density lipoprotein were obtained. High doses of statins were prescribed rarely.

Conclusion. There is a serious therapeutic problem related to the insufficient attention of doctors to examination and treatment of patients with newly-diagnosed severe dyslipidemia, especially when the primary disease is not a cardiovascular one.

385-390 625

Aim. To study the differences in views on treatment among patients with cardiovascular diseases in state and private outpatient clinics, as well as the motivation for choosing one of these outpatient clinics.

Material and methods. Anonymous and voluntary survey of cardiology patients (n=90) in 2 state (57.7%) and 3 private outpatient clinics (42.2%) was conducted in Saratov.

Results. 33.3% of respondents were men; the median age was 65 years. Patients of state outpatient clinics were more likely to have retirement age (p=0.0008), low income (p=0.0006), history of hypertensive crises (p=0.0129) and chronic heart failure (p=0.0001). Patients of private outpatient clinics were more likely to have mental work (p=0.0001), higher education (p=0.0001), moderate income (p=0.0006). The difference in views on the disease and the attitude towards a doctor among patients of state and private clinics was shown.

Conclusion. Patients of private outpatient clinics were more active, young, aimed at continuation of life. They are more likely to have higher education, mental work and moderate income. Patients of state outpatient clinics are "infatuated with their illness"; it is their “lifestyle”. Paternalistic model of communication with doctors is expressed in all the patients.


391-397 859

Aim. To reveal cognitive deficit after coronary artery bypass, the influence of citicoline, piribedil on the state of higher cerebral functions in the early and late periods after surgery.

Material and methods. The study included 94 patients with ischemic heart disease. All patients were divided into 3 groups. Patients of the first group (n=30) were prescribed citicoline as a cerebral neuroprotective drug. Patients of the second group (n=32) had piribedil in addition to standard therapy. Patients of the control group (n=32) had only a standard treatment without any neuroprotective drugs. All patients underwent coronary artery bypass surgery. The cognitive function was assessed before, 10 days after and six months after coronary artery bypass.

Results. Patients of group 1 and 2 had achieved pre-surgical levels of cognitive tests results 6 months after coronary artery bypass. The control group had achieved initial levels only in three tests: visual memory (immediate simulation; p=0.008), categorical association (p=0.002), clock drawing test (Wilcoxon test; p=0,005), while other indices were reduced in comparison with the initial ones.

Conclusion. The obtained results allow considering the studied drugs as a protectors of cognitive function after surgery. Randomized controlled double-blind studies on large samples are needed to confirm these results.


404-412 603

Change of the status of innovative technologies depending on the received evidences is considered. Examples reflecting the initiation of interest in the new technology of treatment, the transition from innovation to standard therapies, as well as the weakening of interest in the previously introduced technology due to disappointing results of clinical trials on evaluation of its effectiveness are presented.


413-419 608

Today the role of disturbances in sleep duration in the development of various chronic diseases, including cardiovascular diseases is known and proven. In addition, the results of many clinical studies demonstrate the relationship between impaired sleep duration and the rate of telomere shortening. In turn, short telomeres are associated with the development of arterial hypertension, chronic heart failure, atherosclerosis and other diseases with high mortality both in Russia and worldwide. This article presents an overview of the clinical studies demonstrating the negative effect of sleep duration disturbances on total and cardiovascular mortality, as well as works that specify in detail the relation between sleep duration and telomere length.

420-425 649

Relationships of pharmaceutical industry with medical science and practice are analyzed. The influence of pharmaceutical industry on clinical trials, journal publications, governmental organizations, physicians and researchers is discussed.

426-430 667

Heart rate variability (HRV) in patients with ischemic heart disease, a life-threatening heart rhythm disorders, as well as diabetes mellitus (DM) is considered. A significant association between the autonomic regulation of the cardiovascular system and death from cardiovascular causes is identified. The reactions of the autonomic nervous system (ANS) can serve as a precipitating factor of arrhythmias in patients with heart disorders. Analysis of HRV at rest is the main and informative method for determination of the ANS disorders. HRV decreases greatly in patients with acute myocardial infarction, cardiac arrhythmia, and DM, predicting a high risk of death. The leading cause of death in diabetic patients is cardiac autonomic neuropathy, with the development of "silent" ischemia and painless myocardial infarction. Autonomic regulation of the heart rate should be assessed for early diagnosis and prevention of complications in the form of sudden death.


431-437 693

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.


438-439 363

To sow reasonable, kind, eternal.

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