Rational Pharmacotherapy in Cardiology

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Vol 3, No 5 (2007)
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4-8 1570

Aim. To evaluate the pre-hospital treatment of patients with acute coronary syndromes (acute myocardial infarction and unstable angina) in 2001 and 2006.

Material and methods. Retrospective pre-hospital treatment survey was performed in 1114 patients with acute coronary syndrome (acute myocardial infarction (AMI) or unstable angina (UA)) in 2001 and 2006.

Results. For acute myocardial infarction use of aspirin, β-blockers, heparin was 0%, 0%, 81,5% in 2001 and 23,9%, 8%, 13,4% in 2006, respectively. Use of aspirin, β-blockers, heparin in unstable angina were 0%, 16,2%, 12,3% in 2001 and 3,4%, 1,6%, 0,5% in 2006, respectively. Fibrinolytic therapy was not provided. Polypragmasia reduced in 2006 in comparison with 2001.

Conclusions. This survey demonstrates the discordance between existing current practice and guidelines for acute coronary syndrome.

8 300

Editorial comment on the article of O.V. Reshetko et al. “Analysis of pre-hospital treatment of acute coronary syndrome”.


9-14 375

Aim. To assess cumulative cardio-vascular (CV) risk and elasticity of big-to-middle size arteries in hypertensive patients depending on age, sex and enalapril (Enap, Dr. Reddy’s) effects on these features.

Material and methods. 143 patients with arterial hypertension of 1-2 stages were split in 3 groups: 1st – patients younger than 55 y.o. (17 men, 27 women before menopause); 2nd – patients aged 55-65 y.o. (16 men, 38 women); 3rd – elder than 65 y.o. (11 men, 34 women). Fatal CV risk according to SCORE scale and cumulative risk of acute coronary disease (CAD) events according to PRCAM program was assessed before and after 4 weeks of enalapril therapy (5-30 mg/d). Besides the speed of pulse wave spread (SPWS) was determined by method of volume sphygmography.

Results. Normal SPWS in elastic arteries was observed in women under 55 y.o. SPWS disturbances were detected in elderly patients. Lower blood pressure (BP) levels and better plasma lipid profile was found in women of young and middle age in comparison with these in men of the same age. More than 80% of hypertensive patients have high CV risk, especially in elderly ones. Enam improved SPWS in elastic arteries, reduced BP and cumulative CV risk.

Conclusion. There are gender and age differences between BP levels, SPWS indices, plasma lipid profiles and cumulative CV risks in hypertensive patients. Enalapril improves these characteristics.

15-19 1804

Aim. To determine the role of immuno-inflammatory responses in the development of acute coronary syndrome (ACS).

Material and methods. 93 patients with acute coronary syndrome (ACS), including 60 patients with unstable angina (UA) and 33 patients with acute myocardial infarction (AMI) were involved in the study. Comparison group included 83 patients with stable angina and control group - 25 healthy persons. The diagnosis of ischemic heart disease (IHD) was verified on the basis of clinical and instrumental data. For assessment of immuno-inflammatory responses levels of C-reactive protein (CRP), pro-inflammatory (interleukins [IL-1β, IL-6], tumor necrosis factor [TNF-α]) and anti-inflammatory (IL-4, IL-10) cytokines we determined by ELISA method.

Results. There were high levels of pro-inflammatory cytokines (IL-1β, IL-6, TNF-α), high CRP level and low levels of anti-inflammatory IL-4, IL-10 cytokines in UA and AMI patients. Insignificant immunological shifts were found in stable angina patients.

Conclusion. Destabilization in the IHD course is characterized with more active immuno-inflammatory responses. Activity of these reactions is associated with ACS severity.

20-23 1110

Aim. To study the effects of antihypertensive therapy based on consideration of individual heart rhythm variability (HRV) on left ventricular hypertrophy (LVH) in hypertensive elderly patients.

Material and methods. 60 hypertensive elderly patients with LVH were included in the study. They were split in two groups (30 people in each one). Patients of the group-I had common antihypertensive therapy. Patients of group-II received medications prescribed with consideration of individual heart rate variability. Holter monitoring with analysis of HRV, 24-hour blood pressure monitoring and ultrasonography were conducted initially and 18 months after treatment beginning.

Results. BP control was reached in the majority of patients of both groups. The patients of group-II in comparison with patients of group-I had reduction of low- high frequency power ratio (LF/HF) and higher rate of LVH reduction. Relationship between LVH dynamics and ratio LF/HF was found.

Conclusion. Arterial hypertension therapy considering individual HRV contributes in LVH reduction in elderly patients.

24-30 4687

Aim. To study effect of cardioselective β-adrenoblocker metoprolol tartrate (in retarded formulation) on quality of life in elderly patients with chronic heart failure (CHF) of ischemic etiology.

Material and methods. 78 patients with CHF class III (NYHA) were involved in the study. Patients were 81,6±0,25 y.o. in average. All patients had clinical signs of mild-to-moderate depressive disorders. Patients were split on 2 groups comparable in sex and age. Patients of the 1st group (n=43) received metoprolol tartrate (Egilok Retard), 50-100 mg/d additionally to standard therapy. Patients of the 2nd group (n=35) received only standard therapy. The somatic status was assessed before and after 1 and 3 months of therapy by clinical condition evaluated scale (CCES), 6-minute walking test, left ventricular ejection fraction (Echocardiography) as well as mental status by special tests (SMSP, BDI, Hamilton scale, C.D.Spilberger-Y.L.Hanin scale) and qualities of life (MLHFQ, SF-36).

Results. Reduction of CHF class from III to II was observed in 31 (76,7%) patients of the 1st group and in 23 (65,7%) patients of the 2nd group. Tolerability of Egilok Retard was good and there were not cessations because of side effects. In 3 months of therapy severity of the somatic status according to CCES reduced more significantly in the 1st group in comparison with the 2nd group (29,5 % vs 11,5 %, p <0,001). The exercise tolerance increased higher in the 1st group comparing with the 2nd one (34 % vs 17 %, respectively, p<0,001). The severity of depression reduced (according to SMSP, Hamilton scale) more significantly in the 1st group in comparison with this in the 2nd one. Quality of life also improved more significantly in the 1st group according to MLHFQ and SF-36 (physical functions, role physical functions, social function scales) at the end of therapy.

Conclusion. Metoprolol tartrate (in retarded formulation) improves somatic and mental status as well as quality of life in elderly patients with CHF.

31-36 414

Aim. To study the effect of enalapril on functional activity and vitality of polymorphonuclear cells in rheumatic heart disease complicated by congestive heart failure.

Material and methods. 81 patients with rheumatic heart disease and valvular disease were examined. There were 37 males (average age 53,6±9,7 y.o.) and 44 females (average age 56,2±9,6 y.o.). 25 healthy donors were involved as a control group. Neutrophils were isolated from the whole blood and cultivated during 6 h. Level of neutrophil nitric oxide production was assessed. Chemiluminescent assay was used to evaluate oxidative metabolism of neutrophils. Self-apoptotic activity of neutrophils was investigated by the determination of molecule bak on the surface of cellular membranes.

Results. Redox metabolism and oxidative potential of granulocytes were increased in patients with rheumatic heart disease. Enalapril inhibited neutrophil functional and apoptotic activity and had favorable influence on the system of plasma antioxidant protection.

Conclusion. The effect of enalapril can be associated with the increase of bradykinin and inhibition of angiotensin playing regulatory role in neutrophil function. Antiapoptotic effect of enalapril, probably, related to the modification of nitric oxide synthesis.

39-44 691

Aim. To study clinical equivalence of two amlodipines under the control of their plasma levels and evaluate their pharmacoeconomical efficacy in patients with arterial hypertension (AH).

Material and methods. 31 patient with AH were included in the study (14 men and 17 women). 21 (66 %) patients had AH of 1 stage and 10 (34 %) patients had AH of 2 stage. All patients were 39-81 y.o. (average - 60 y.o.) with AH duration 0,5-43 years (average - 17,9 years). Antihypertensive effect of Amlorus (Synthesis, Russia) and Norvasc (Pfizer, USA) was evaluated in the study. Blood pressure (BP), amlodipine plasma levels (by liquid chromatography with mass spectrometry) and side effects were registered before and after 2, 4 and 6 weeks of therapy. Hydrochlorothiazide 25 mg/d was added if the monotherapy with amlodipine10 mg/d had not been efficient. Therapy with the second studied amlodipine followed the therapy with the first drug.

Results. Both drugs provided similar plasma amlodipine concentrations with significant BP reduction. 96,6 % and 90 % of patients reached BP target level (<140/90 mm Hg) after 6 weeks of Amlorus and Norvasc therapy, respectively. Hydrochlorothiazide was needed in 23,3 % and 26,7 % of patients taking Amlorus and Norvasc, respectively. Cost of Amlorus therapy per patient was 221 rbl/month in comparison with cost of 727 rbl/month for Norvasc therapy.

Conclusion. Generic Amlorus showed clinical and pharmacokinetic equivalency with an original amlodipine Norvasc and lower cost of therapy.

45-53 1733

Aim. To evaluate effects of angiotensin converting enzyme inhibitor spirapril on efficacy of preventive antiarrhythmic therapy in patients with paroxysmal atrial fibrillation (AF).

Material and methods. 40 patients with paroxysmal AF were involved in open-label, cross-over study with periods of antiarrhythmic drug withdrawal. During 3 months all patients received by turns two types of therapy: combination of preventive antiarrhythmic therapy with spirapril 6 mg once daily - (CT group) or preventive antiarrhythmic therapy only (AT group).

Results. AF-free intervals to the first and the second AF paroxysms during antiarrhythmic drug withdrawal were comparable ) in AT and CT groups (p=0,4 and p=0,6, respectively, logrank test).

Conclusion. Spirapril added to the basic preventive antiarrhythmic therapy during 3 months had no effect on the length of interictal period in paroxysmal AF.

54-57 3649

Aim. To compare efficacy of bisoprolol and bisoprolol+metformin combination in patients with arterial hypertension (AH) and metabolic syndrome (MS).

Material and methods. 20 patients with AH and MS were involved in the study. They were randomized in 2 groups, 10 patients in each group. Patients of the 1st group received bisoprolol. Patients of the 2nd group received combination of bisoprolol and metformin. Blood pressure (BP), body mass index (BMI), carbohydrate metabolism, lipid profile, microalbuminuria (МАU) level was determined before, within and at the end of 24-week treatment.

Results. Both treatments resulted in similar reduction in BP. Reduction of BMI and insulin plasma concentration was more significant in patients received combined therapy. Both treatments improved lipid profile and reduced MAU.

Conclusion. Bisoprolol has positive effect on pathogenic mechanisms of AH and MS. Metformin additionally improves carbohydrate and lipid metabolism.

58-61 2170

Aim. To evaluate changes in hereditary burden of sick sinus syndrome (SSS) in families of patients with SSS and assess heart rate variability (HRV) in patients with SSS.

Results. 33 families of patients with SSS were examined. Clinical study, ECG-Holter monitoring, atropine test, transesophageal left atrial stimulation, echocardiography, veloergometry were fulfilled in all probands and their relatives in 1990 and 2005-2006. Cardiorhythmography was done in patients with SSS only in 2005-2006.

Results. Increase in hereditary burden with SSS from 31 to 35% is registered during 15 years. Significant growth of patients with SSS was observed among daughters (from 50 to 71%), nephews (from 33 to 50%) and nieces (from 0 to 20%). HRV analysis shows prevalence of sympathetic system activity in patients with SSS.

Conclusion. Growth of hereditary burden with SSS especially among female relatives is shown. HRV analysis can be used for SSS diagnostics.

62-68 451

Aim. To study change of rate and duration indicators of longitudinal movement of a fibrous ring of mitral valve (MFR) during isovolumic contraction (IVC) and relaxation (IVR) in hypertensive patients with various degree of a left ventricular hypertrophy (LVH).

Material and methods. 80 hypertensive patients with moderate LVH (n=40) and severe LVH (n=40) are examined. The control group was presented by 30 healthy volunteers. Transthoracic echocardiography and Tissue Doppler imaging has been performed with ultrasonic tomograph “HDI 5000” (Philips).

Results. Increase in LVH (Smm) and Е/Еmm associates with reduction in systolic velocity of movement of medial MFR (Smm). There is direct relation with duration of IVC-negative and IVR-positive components and myocardium mass index. Maximal velocity of IVC-positive component increases and maximal velocity of IVR-negative component decreases when LVH is growing.

Conclusion. Velocities curves of IVC and IVR were bi-phase both in healthy persons and in hypertensive patients with LVH. Velocity and duration of positive and negative components of IVC and IVR depended on LVH degree.


69-72 798

Aim. To study parameters of a renal hemodynamic and the general glomerular filtration rate (GGFR) and their correlations with cardiovascular risk factors (RF) in patient with arterial hypertension (AH).

Material and methods. 102 patients with AH (35 men and 67 women of 40-60 y.o.) were involved in the study. 20 persons (10 men and 10 women) with normal blood pressure (BP) were included in control group. Dynamic renal angioscintigraphy was used for an estimation of a renal hemodynamic and GGFR.

Results. Hypertensive women had lower renal blood flow and GGFR than these in men (p<0,000). Renal hemodynamics and GGFR in men and women did not differ in control group. Positive correlation  r=0,61; p<0,05) between GGFR and a tobacco smoking was found in hypertensive men as well as negative correlation (r=-0,41; p<0,005) between GGFR and body mass index (BMI) in women.

Conclusion. Renal blood flow and GGFR are lower in hypertensive women than these in men. Positive correlation between GGFR and tobacco smoking and negative correlation between GGFR and BMI were found in men and women respectively.


73-78 1996

Importance of thrombolytic therapy for restoration of coronary blood flow in acute myocardial infarction is emphasized. Indications and contraindications, advantages and disadvantages for thrombolysis therapy are discussed. The ways of different thrombolytics implementation, efficacy criteria and possible side effects are also presented.


79-82 601

Data of multicenter clinical trials on assessment of angiotensin converting enzyme inhibitor, lisinopril efficacy in therapy of patients with arterial hypertension, heart failure, myocardial infarction complicated with left ventricle dysfunction and diabetes (GISSI-3, ATLAS, ALLHAT, EUCLID) are presented in the review. The results of these trials establish more active usage of lisinopril in clinical practice.

83-87 1508

The cardiovascular morbidity in developed countries has decreased, but only in men and it has increased in women. The risk of cardiovascular diseases in premenopausal women is 2-4 times less than this in men. A role of hormone replacement therapy for postmenopausal women in primary and secondary prevention of cardiovascular diseases is reviewed. The results of retrospective and plaсebo-controlled trials are presented. Cellular cardioprotective mechanisms of action of female sex hormones are shown.


88-111 2137

The Task Force on Diabetes and Cardiovascular diseases of the European Society of Cardiology and of the European Association for the Study of Diabetes.

112-114 324

Comments on Guidelines on diabetes, pre-diabetes, and cardiovascular diseases ESC-EASD 2007.

115-120 340

Whether the study on efficacy of rosuvastatin in elderly patients with heart failure and systolic dysfunction of left ventricle had been completed with “crowning”?

121-122 3488

News of Congress of American heart association.

123-125 2360

On the anniversary of academician R.G. Oganova.

126-128 266

Russian National congress of cardiologists, 7-9 October, Moscow.

129 251

Higher Certifying Commission News.

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