Aim. Estimation of social, demographic and anamnestic characteristics of patients survived cerebral stroke as well as the medical treatment received by the patients before the reference stroke in the hospital and at discharge within the framework of the stroke register LIS-2 (study of mortality among patients survived stroke in Lyubertsy district).

Material and methods. All the patients (637 persons) admitted to the Lyubertsy regional hospital №2 due to stroke from 01.01.2009 to 31.12.2010 were enrolled into the study.

Results. 36% were men and 64% were women with mean age of 70.99Ѓ}9.6 years old. 554 (87.0%) patients had history of arterial hypertension and 155 (24.3%) – of atrial fibrillation.147 (23.1%) patients had previous stroke. In-hospital mortality made up 21.8% (mean age of 139 deceased patients was 72.7Ѓ}9.6 years old). 374 (75%) patients were prescribed ACE inhibitors, 421 (85%) - antiplatelet agents, 4 (1%) – warfarin. Statins intake was recommended to 3 (1%) patients.

Conclusion. We revealed low frequency of prescription of drugs with proven positive prognostic value in patients after stroke.

Aim. To analyze adverse drug reactions (ADR) during antithrombotic therapy on the basis of spontaneous reports registered in Volgograd city and region in 2010-2012.

Material and methods. It was analytical retrospective pharmacoepidemiological study. ADR spontaneous reports submitted to the Volgograd Regional Centre for Drug Safety Monitoring were used.

Results. Regarding antithrombotic drugs 18 spontaneous reports on suspected ADR or ineffectiveness were submitted (from 562). Most of reports were accounted for by indirect- acting anticoagulating agents — 66.7% (12/18), direct-acting anticoagulants — 22.2% (4/18), and antiplatelet drugs 11.1% (2/18).

Conclusion. Warfarin was more often cause of ADR during antithrombotic therapy. Organization of regional centers for drug safety monitoring can contribute to ADR reveal and study.

Aim. To compare the 24-hour indicators of heart rate variability (HRV), adjusted for age and 24-hour average heart rate (HR24) in women with rheumatoid arthritis (RA) and women of the control group.

Material and methods. Women with RA (n=291) at the age of 20-60 were examined. Women without rheumatic diseases (n=125) were included into control group. The presence of traditional cardiovascular risk factors, the results of 24-hour ECG monitoring were assessed in addition to clinical symptoms, RA activity and severity. Transformation of the initial HRV parameters in their logarithms, and the standardization of the logarithms of age and HR24, the calculation of the exponential of the standardized logarithm were performed to remove the effects of age and heart rate on HRV.

Results. Time and frequency HRV indices, adjusted for age and HP24 (HRVa) in women with RA were lower than these in women of control group. HRVa decline was observed in 14–24% of women with RA. The maximum HRVa decrease was observed among the parameters that reflect an activity of parasympathetic autonomic nervous system (RMSSDn, pNN50n, HFn).

Conclusion. The young and middle age women with RA differ from the women of the control group in significant decrease in the time and spectral HRV indices adjusted for age and HR24.

According to the data from PROGNOZ IBS register drugs with proven efficacy in secondary prevention of cardiovascular complications (antiplatelets, β-blockers, ACE inhibitors, statins) were not often prescribed in patients with stable ischemic heart disease prior to hospitalization. Significant improvement of the treatment quality was found during the cardiology hospital stay. The prescription rate of ACE inhibitors increased from 20% to 84.4%, statins - from 10% to 85.5%, β-blockers - from 20% to 91%, acetylsalicylic acid - from 74% to 96%. However, some drugs (statins) have been used in inadequate doses. Low-density lipoprotein level <2.5 mmol/L was achieved at discharge only in 6.3% of patients.

Aim. To assess the quality of lipid-lowering therapy in high risk patients with cardiovascular diseases during medical supervision in specialized center.

Material and methods. The data of the PROFIL register are used. All patients having cardiovascular diseases, high cardiovascular risk, and seeking medical attention in specialized medical center were enrolled into this register. Patients (n=274) were split into groups: control group (n=82, patients who have applied for the first time for medical care), the main subgroup A (n=167; patients observed last 2 years), and the main subgroup B (n=25; patients observed more than 2 years).

Results. The total cholesterol blood level was significantly lower in the main group compared to the control (p<0.05). Statins were constantly taken by 34% of patients in the control group, 71.6% - in subgroup A, and 61% - in subgroup B (p<0.05).

Conclusion. Medical supervision in specialized medical center leads to better blood lipid control and patient compliance to statin therapy.

Questions of statins use in liver diseases are discussed. Data from clinical studies on statins safety in cardiac patients with liver diseases are presented. Features of statins use in nonalcoholic fatty liver disease, viral hepatitis C are considered separately.

The electrocardiogram remains a crucial tool for the identification of myocardial ischemia. Important information for patient management and prognosis determination can be derived from the stress testing electrocardiogram. Leads with ST-segment elevation indicate the ischemia related coronary artery.

Aim. To evaluate the effect of parathyroidectomy and cinacalcet on anemia, lipid profile and blood pressure (BP) in uremic hyperparathyroidism.

Material and methods. Uremic patients (n=39) treated with hemodialysis and having secondary hyperparathyroidism were included into the study. Radical parathyroidectomy was performed in 21 patients, 18 patients were treated with cinacalcet. BP measurement, determination of blood levels of albumin, total calcium, phosphorus, total cholesterol (TC), low (LDL) and high density lipoproteins, triglycerides, intact parathyroid hormone, and hemoglobin were performed in all patients initially and during treatment. Doses of antihypertensive and erythropoiesis-stimulating agents were also assessed.

Results. Calcium-phosphorus metabolism indices improved after 6 months of cinacalcet therapy and parathyroidectomy (p<0.05). BP reduction not requiring antihypertensive drugs dose adjustment was found in patients treated with cinacalcet. Significant BP reduction (p<0.05) was observed after parathyroidectomy and it required antihypertensive drugs cancellation or dose lowering. Cinacalcet therapy and parathyroidectomy led to increase in hemoglobin level by 2.02% (p=0.143) and 7.6% (p=0.029), respectively, as well as reduction in weekly dose of erythropoiesis-stimulating drugs by 2.7% (p=0.875) and 8.9% (p=0.751), respectively. Significant (p<0.05) decrease in LDL (5.6%), and triglycerides (23.7%) levels was found in patients treated with cinacalcet. Reduction (p<0.05) in total cholesterol (1.4%) and LDL (4.3%) levels was observed after parathyroidectomy.

Conclusion. The pleiotropic effects (reduction in BP and atherogenic lipids levels, as well as decrease in anemia resistant to the action of erythropoiesis-stimulating agents) were found after parathyroidectomy and cinacalcet therapy additionally to calcium-phosphorus metabolism improvement.

Various aspects of the therapy of patients with cognitive impairments and vascular comorbidity, including cerebral stroke and chronic brain ischemia associated with cardiac and endocrine diseases are discussed. Influence of vascular cognitive and psycho-emotional disorders on the social and everyday activity is demonstrated. Clinical studies of efficacy and safety of vinpocetine treatment in these patients are presented.

Insulin resistance plays the main role in the pathogenesis of diabetes mellitus and its complications. It is also a major factor of the pathology associated with age, which leads to accelerated aging. Data about the role of insulin resistance and its correction in vascular aging are presented.

Studies data on new anticoagulants, direct oral thrombin inhibitor (dabigatran) and direct inhibitors of coagulation factor Xa (rivaroxaban, apixaban), in the treatment of nonvalvular atrial fibrillation are presented. Effects of these drugs on cardiovascular events in atrial fibrillation are analyzed based on the results of various studies. Prospects for further research are discussed.

Data on the updated approach to the choice of two-component antihypertensive combinations for different clinical situations are presented. Advantages and indications for combination of an angiotensin converting enzyme (ACE) inhibitor and dihydropyridine calcium antagonist are considered. Data on the efficacy and safety of the combination of calcium antagonist of the third generation, lercanidipine, and ACE inhibitor, enalapril, are presented.

Indications for myocardial cytoprotector, trimetazidine, in patients with ischemic heart disease are analyzed and justified according to evidence based medicine. Results of a multicenter randomized comparative KARDIOKANON study are discussed in terms of efficacy and tolerability of two variants of the complex 12-week treatment in patients with angina II-III functional class, based on the original and generic drugs. The study showed clinical equivalence of the generic DeprenormR (Canonpharma Production) to the original trimetazidine.

G. Savarese, P. Costanzo, J.G.F. Cleland, E. Vassallo, D. Ruggiero, G. Rosano, P. Perrone-Filardi «A Meta-Analysis Reporting Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients Without Heart Failure» J Am Coll Cardiol 2013;61(2):131-42;   http://dx.doi.org/10.1016/j.jacc.2012.10.011

Comments to the paper G. Savarese et al. A Meta-Analysis Reporting Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients Without Heart Failure

Comments to the paper B.A. Ference, et al. 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 (translation is published in №1 2013:90-98)