Rational Pharmacotherapy in Cardiology

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Vol 7, No 2 (2011)
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133-136 273

Principles and fundamentals of proper presentation of observational epidemiological study results are focused. Principles of observational study publication developed by expert epidemiologists (STROBE statement) are explained in detail.


137-144 320

Aim. To evaluate cardiovascular risk factors prevalence among physicians of therapeutic profile (cardiology , internal medicine, neurology , endocrinology etc), to estimate awareness of physicians about their own cardiovascular risk, and to simultaneously assess their expertise in up-to-date clinical guidelines. Material and methods. A total of 638 physicians working in out-patient and in-patient clinics of Moscow, Moscow region, St-Petersburg, Nizhniy Novgorod, Vladivostok, Irkutsk, Krasnoyarsk, Krasnodar and Perm were included into the study. The mean age of participants was 46 years. The mean professional experience – 20.4 years. We made an assessment of main cardiovascular risk factors, and conducted interactive inquiry , which included questions about preventive and treatment measures for cardiovascular diseases. Results. Arterial hypertension (HT) was revealed for the first time in 178 physicians, 150 physicians indicated HT in anamnesis. Only 64 physicians had target levels of blood pressure. Hypercholesterolemia rate was 45%. The prevalence of obesity and overweight were 22% and 39%, respectively. Inquiry showed that 53% of physicians primarily use clinical guidelines to choose treatment options. 76% and 88% of physicians considered it possible to achieve target levels of blood pressure and of low-density lipoprotein-cholesterol, respectively. Conclusion. Prevalence of main risk factors among physicians was similar to that in the total population; correction of those risk factors was not satisfactory. Knowledge of cardiovascular risk problems and necessity of their correction was adequate in the whole; however physicians often failed to apply their knowledge to practice.

145-150 599

Aim. To evaluate clinical and cost effectiveness of different reperfusion strategies in myocardial infarction with ST segment elevation (STEMI), including pre-hospital thrombolysis with tenecteplase.  Material and methods. Methods of cost-effectiveness analysis and economic modeling were used to calculate the costs of reperfusion in STEMI, expected number of life gains, the cost of life gains depending on reperfusion strategy (no reperfusion, percutaneous coronary intervention (PCI), prehospital thrombolysis, hospital thrombolysis).  Results. In accordance to analysis results and from economic point of view, the most effective strategy is primary PCI in patients within "therapeutic window" and pre-hospital thrombolysis in the remaining patients with STEMI. More complex strategy of patients flow control with patient division into groups of primary PCI, pre-hospital thrombolysis and hospital thrombolysis lead to decrease in reperfusion costs efficacy.  Conclusion. The reperfusion model with primary PCI in the first 120 minutes after STEMI symptoms onset, and pre-hospital thrombolysis with bolus thrombolytic administration, when PCI is not possible in this period, is the most effective economically and in respect on mortality reduction in patients with STEMI.

151-157 273

Aim. To elaborate additional electrocardiographic (ECG) criteria for evaluation of the thrombolytic therapy (TLT) efficacy  in patients with acute coronary syndrome (ACS) with ST segment elevation with discriminant model construction. Material and methods. TLT with streptokinase was performed in 123 patients (108 men, 15 women) with ACS with ST segment elevation in the first 6 h after symptoms onset. Streptokinase i.v. infusion was performed in dose of 1.5 million IU. ECG was recorded at baseline and after TLT. Results. Additional ECG criteria for evaluation of TLT efficacy was elaborated in patients with ACS with ST segment elevation: sum of ST segment elevations in 12-lead; ratio of registered QT interval duration to proper corrected QT interval; corrected variance. Among 123 patients elaborated model was correct in 92.7% of cases. Conclusion. Elaborated discriminant model provides an opportunity to specify effective, uncertain and ineffective TLT within 3 h after TLT.

158-166 490

Aim. To estimate the economic damage by acute coronary syndrome (ACS) in Russia in 2006-2009. Material and Methods. Direct costs and economic losses associated with ACS were estimated. The structure of direct costs includes the costs of hospitalization, medical emergencies, out-patient visits, high-tech medical care, as well as drug therapy in outpatient treatment. Losses in the economy associated with ACS include loss of gross domestic product due to death in working-age, temporary disability and payments of disability benefits. Estimation of economic damage by cardio-vascular diseases was based on analysis of Russian Ministry of Health official statistics. Results. Approximately 520,000 cases of ACS are registered annually (36,4% - myocardial infarction, 63,6% - unstable angina). Trend to increased mortality from myocardial infarction, especially among women, was found during the analyzed period. From 2000 to 2009 this index rose from 34.9 to 41.1 per 100,000 of population among women, and from 52.3 to 55.9 per 100,000 of population among men. Total direct costs of health care for patients with ACS in 2009 amounted to almost 21 billion rubles, and indirect – 53.5 billion rubles. The total economic damage by ACS in Russia in 2008-2009 exceeded 70 billion rubles per year. Conclusion. ACS in Russia is connected with significant social and economic damage. Most part of this damage is indirect losses in economy due to premature mortality of working aged men.

167-173 536

Aim. To study the clinical equivalence of original and generic drugs of bisoprolol in patients with arterial hypertension (HT) 1-2 degrees according to protocol recommended by the Society of Cardiology of the Russian Federation for comparative studies. Material and methods. 30 patients with HT 1-2 degrees were examined. Patients were randomized into group 1 (original bisoprolol 5 mg/day) or group 2 (generic bisoprolol 5 mg/day). In case of insufficient antihypertensive effect bisoprolol dose was increased or S-amlodipine and then indapamide were added. After the first treatment period (8 weeks) was completed 2-week wash-out period started and then the second period (8 weeks) of treatment (taking alternative medicine of bisoprolol) began. Blood pressure (BP), heart rate, ECG, adverse effects were recorded in patients. Results. After 8 weeks of therapy BP reduction was 27.2±12.2/12.0±6.1 mm Hg in group 1 and 29.9±10.5/12.5±7.2 mm Hg in group 2 (p<0.001 for both groups), intergroup differences were insignificant. Target BP levels were achieved in 79.3% of patients in both groups. Heart rate decrease was 11.1±12.9 in group 1 and 8.5±8.6 beats/min in group 2 (p<0.05 for both groups). Significant dynamics of PQ interval were not found in both groups. The groups were comparable in terms of treatment safety and tolerability. Conclusion. Therapeutic equivalence of original and generic bisoprolol is shown in patients with HT 1-2 degrees.

174-176 250

Aim. To study the association of hereditary sick sinus syndrome (SSS) with connexin 40 gene (Cx40) polymorphism. Material and methods. 29 families with hereditary SSS were involved into prospective study. Probands were 20 women and 9 men (aged 58±0.15). Relatives, I-III degree of kinship, were 65 men and 68 women (aged 39±0.13). Clinical and instrumental examination was performed in all probands and their relatives. Diagnosis of SSS was verified by transesophageal atrial electrostimulation. Molecular genetic investigation of SSS patients and their relatives was carried out in laboratory of medical genetics of Research Institute of Therapy , Siberian Branch of Russian Academy of Medical Sciences. Results. 71 SSS patients, 44 their healthy relatives, I-III degree of kinship, 197 subjects of control group were genotyped for the polymorphism of 44G>A of gene Cx40. According to allele-specific polymerase chain reaction 3 types of genotypes ADRA2B (II — homozygous wild, ID — heterozygous, DD — homozygous mutant) were found in SSS patients, their relatives and healthy subjects of control group. Conclusion. Significant predominance of the heterozygous genotype 44G>A was found in SSS (45,07±5,9%) patients in comparison with subjects of the control group (29,44±3,2%).

177-184 328

Aim. To analyze current clinical practice in the treatment of atrial fibrillation (AF) in emergency care department of multidisciplinary hospital in 2008-2009. Material and methods. Retrospective continuous pharmacoepidemiology study was carried out. Hospital history sheets of the patients admitted to the emergency care department in the period from 01.01.2008 to 31.12.2009 were analyzed. Results. Physicians of emergency care department mainly chose strategy of sinus rhythm restoration and maintenance in patients with paroxysmal and persistent AF . To implement this strategy pharmacological cardioversion was performed in patients with stable hemodynamics. The most frequently used medicine for pharmacological cardioversion was procainamide (60% of all prescriptions). Its efficacy was about 50% as compared with this of 80% for amiodarone and propafenone. In order to maintain sinus rhythm monotherapy with beta-blockers or amiodarone was preferred. Conclusion. Overall, AF treatment corresponded to current guidelines. Physicians preferred strategy of sinus rhythm restoration and maintenance.

185-192 383

Aim. To study the retina state by functional methods in patients with arterial hypertension (HT) of various degrees. Material and methods. Patients with uncomplicated HT of 1-3 degrees (n=81) and healthy subjects (n=20) of control group were examined. Routine (direct ophthalmoscopy) and functional (evaluation of contrast and color sensitivity of the retina, electroretinography) methods were used. Results. Functional retinal changes (reduction in color and contrast sensitivity) progressed with increasing HT degree. These changes were located in the area of central retinal artery (paramacular area) and area of choroidal blood flow (macular region). Retinal bioelectrical activity disturbance was also found by the electroretinography. Conclusion. The identified functional disorders suggest the retina involvement in the pathological process even in the early HT and may be associated with its severity. It confirms a relationship of HT with disorders of eye as a target organ in HT. Published data and results of our studies can refute the point of view about impossibility of changes assessment on the eye fundus in patients with uncomplicated HT, and indicates that it was premature exclusion of the eye from the list of target organs in HT.


193-198 957

Aim. To evaluate effect of bisoprolol on circadian blood pressure (BP) profile, autonomic cardiovascular regulation, lipid and carbohydrate metabolism in young patients with arterial hypertension (HT) and obesity. Materials and methods. 36 men aged 18 to 35 years with HT 1-2 degrees, obesity 1-2 degrees and signs of sympathetic over activity were examined. In addition to standard clinical examination assessment of heart rate variability (HRV) during orthostatic test with spectral analysis, ambulatory BP monitoring, evaluation of lipid profile, oral glucose tolerance test, determination of immunoreactive insulin, insulin resistance index and functional activity of beta-cells were performed. Anthropometric measurements included body mass index and waist circumference. Bisoprolol in the initial dose of 5 mg QD orally for 12 weeks was assigned to all patients. After 12 weeks of bisoprolol treatment repeated examination was performed. Results. Significant changes in HRV after 12 weeks of treatment with bisoprolol was found. Parasympathetic influence of autonomic nervous system increased during orthostatic test. Contribution of the slow and very slow waves, which reflect sympathetic and neurohumoral activity , reduced. Total spectral power was significantly increased. Initial tachycardia reduced. Target BP values were achieved after 12 weeks of treatment with bisoprolol 5 mg QD. Increase in a number of dippers and decrease in a number of nondippers in terms of both systolic and diastolic BP was observed. Heart rate and HRV was significantly decreased. No adverse events in terms of lipid or carbohydrate metabolism were found during treatment with bisoprolol. Conclusion. Bisoprolol 12 week treatment resulted in sympathetic activity decrease and parasympathetic activity increase, achievement of BP target levels, improvement of BP circadian profile. Bisoprolol therapy in dose of 5 mg/day demonstrated metabolic neutrality in patients with risk factors of cardiovascular diseases and type 2 diabetes.


199-203 304

Data about chronic thromboembolic pulmonary hypertension (CTPH) prevalence is presented. The main CTPH clinical manifestations are described. The possible reasons and pathogenetic mechanisms of CTPH development are discussed. Features of unfavorable disease prognosis are also presented. Indications, results, limitations for CTPH surgical treatment are shown. Data of the currently completed clinical studies on bosentan, prostacyclin analogues and phosphodiesterase-5 inhibitors usage in CTPH are presented.

204-211 279
Sudden cardiac death etiologicy in different diseases is analyzed as well as its prevalence in different ages, risk factors and prevention.
212-218 325

The main issues of sudden cardiac death (SCD) epidemiology and risk stratification were considered. High efficacy SCD prevention with implanted cardioverter-defibrillators is shown. However they are rarely implemented in the real practice. That is why the main current approach to SCD prevention is pharmacotherapy. Overview of various drugs is given. The largest evidence base and proven efficacy have beta-blockers among all available drugs for SCD prevention.

219-226 328

Arterial hypertension (HT) is a reason for raising a question about need for antithrombotic therapy. At the same time, increased blood pressure associated with an increased risk of hemorrhagic complications. Possible ways to minimize the hemorrhagic risk in different groups of hypertensive patients who need in antithrombotic therapy are discussed.


227-230 724

Contemporary scientific data about mode of action of calcium channel blocker — amlodipine, its pleiotropic effect (influence on endothelial function and antiatherogenic action) is presented. Amlodipine reduces proliferation of vascular smooth muscle cells and extracellular matrix, improves the vasodilating function of endothelial cells although they have no L-type calcium channels. It puts into action through stimulation of nitric oxide (NO) secretion in endothelium. Results of experimental studies on the role of S- and R-isomers of amlodipine in hemodynamic and pleiotropic effects are presented. S-isomer is pharmacologically active blocker of L-type calcium channel while the R-isomer is responsible for NO release. Drugs based on S-amlodipine have been developed. Bioequivalence of the S-amlodipine and amlodipine in doses of 5 and 10 mg, respectively , is shown. Mean values of systolic and diastolic blood pressure, heart rate were not different significantly according to pharmacodynamic studies of S-amlodipine 5 mg and amlodipine 10 mg. S-amlodipine demonstrated better tolerability and lower incidence of ankle edema than amlodipine. Further long-term studies on S-amlodipine effect on hard endpoints are needed.

231-240 388

The evidences for statin use in cardiology are presented. Especially hypolipidemic efficacy of atorvastatin is demonstrated in according to comparative studies. Results of clinical studies on atorvastatin efficacy and safety in different groups of patients are also presented.

241-245 401

The problem of generic drugs use in clinical practice and confirmation of their therapeutic equivalence is discussed. The significance of studies on generic drugs bioequivalence, as well as details of international practice and regulations in this area is explained.


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ISSN 2225-3653 (Online)