Rational Pharmacotherapy in Cardiology

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Vol 7, No 3 (2011)
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275-287 384

Aim.  To  evaluate  effect  of  therapeutic  training  and  active  outpatient management  on  clinical  state  and  cardiovascular  complications  (CVC)  in  patients with  chronic  heart  failure  (CHF)  during  three year follow-up. Material and methods. A total of 211 patients with CHF experienced Q-wave myocardial infarction were enrolled in the study. At admission to the hospital all patients were randomized into two groups. Patients of the first group (group 1; n=106) were managed actively after discharge from the hospital, patients of the second group (group 2; n=105) - managed conventionally after discharge from the hospital. In the hospital patients of the both groups were therapeutically trained and treated according to contemporary guidelines. Patients were observed for three years.  Results. Over three year follow-up actively managed patients demonstrated significant (p<0.05) decrease in systolic and diastolic blood pressure, heart rate, blood serum levels of total cholesterol and N-terminal prohormone of brain natriuretic peptide (NT-proBNP), augmentation of 6-minute walk-test distance, deceleration of heart remodeling and left ventricle ejection fraction reduction as compared to those who were conventionally managed. Kaplan-Meier curves revealed that risk of CHF decompensation (р=0.001), mortality (р=0.04), and total number of CVC (р=0.04) was significantly lower in the first group than this in the second one. Conclusion. Therapeutic training and active outpatient management in patients with CHF improves patient compliance to pharmacotherapy , their clinical state and outcomes.

288-293 447

Aim. To compare the efficacy and safety of carvedilol in men and women with mild to moderate arterial hypertension, associated with obesity and/or compensated diabetes type 2. Material and methods. Hypertensive patients (n=592, 176 men and 416 women) with obesity and/or diabetes were involved into randomized comparative open-label study in parallel groups. Patients were randomized into two groups. Patients of group A (n=291: 90 men and 201 women) kept on to receive previous antihypertensive drugs except beta-blockers which were withdrawn and replaced with carvedilol (Acridilole®, PLC “Akrikhin”, Russia). Patients of control group (n=301: 86 men and 215 women) kept on to receive only previous antihypertensive drugs. Efficacy of antihypertensive therapy was assessed at every 2-week visits during 24-week observation. Biochemical parameters of glucose and lipid metabolism, 12-lead ECG were evaluated at baseline and at the end of the study. Target blood pressure (BP) achievement and safety was assessed in 24 weeks of treatment. Results. Women had more severe metabolic abnormalities compared with men. By the 24th week of treatment significant reduction in systolic BP , diastolic BP , and heart rate was found in the both groups of patients regardless of gender , intergroup differences were significant (p<0,05). By the end of the study target BP level was achieved in 96.3% of men and 96,8% of women in group A and 85.9% and 88.8%, respectively , in the control group (p<0,001). The number of hospital admissions decreased in 4.8 times in men (p<0.0001) and 12 times - in women (p<0.05) in group A, and in 2.7 and 3.3 times, respectively , — in the control group (p<0.0001). Mild to moderate side effects were observed in 32 patients: 19 and 13 patients in group A and control group, respectively (p=0.58). Adverse event rate was not distinguished significantly between men and women. Conclusion: The results show comparable high efficacy and safety of carvedilol in hypertensive men and women with concomitant diseases and high metabolic and cardiovascular risk.

294-299 462

Aim. To study the dynamic of metabolic disorders in patients after hysterectomy with intact ovaries. Material and methods. 104 women (aged 44.0±2.1) after hysterectomy with intact ovaries were examined. All patients were split into three subgroups according to time after hysterecto- my (1, 3, and 5 years). 25 women (aged 43.0±1.6) with normal menstrual function were included into the control group. Blood pressure (BP) levels and body mass index were measured. Serum lipids profile, plasma levels of immune-reactive insulin (IRI) and C-peptide were investigated in fasting condition and after oral glucose tolerance test. Results. Increase in time after hysterectomy was associated with significant elevation of body mass index, systolic and diastolic BP , basal and stimulated IRI and C-peptide levels, as well as serum levels of total cholesterol and low density lipoprotein cholesterol. These parameters had significant positive correlations with time after hysterectomy. Conclusion. Polymetabolic disorders were more prominent in patients with longer time after hysterectomy. These findings can be basis for definition of post-hysterectomy metabolic syndrome stages.

300-305 872

Aim. To compare effects of perindopril and losartan potassium on the parameters of the ambulatory blood pressure (BP) monitoring (ABPM) and circadian BP profile in patients with arterial hypertension (HT) and stenotic coronary atherosclerosis before myocardium revascularization. Material and methods. 59 patients with HT degree 2-3 at the age of 35-69 were examined. ABPM was performed in all patients. Daily profile was assessed by the degree of nocturnal BP reduction. Patients were randomized to receive perindopril or losartan potassium. Perindopril was administered at dose of 4 mg/day with subsequent rising up to 8 mg/day in next 7 days. The initial dose of losartan potassium was 25 mg with subsequent rising up to 50 mg 2 times a day. Duration of observation was 8 weeks. Results. Perindopril reduced 24-hour and daytime systolic BP (SBP) by 17.2% (p<0.0001), nighttime SBP - by 22.5% (p<0.0001), 24-hour and daytime diastolic BP (DBP) - by 18.3% and 17.6% (p<0.0001), respectively , nighttime DBP - by 27.2% (p<0.0001). Losartan potassium reduced 24-hour SBP by 25.7% (p<0.0001), daytime SBP - by 23.6% (p<0.0001), night-time SBP – by 25.5% (p<0.0001), 24-hour DBP - by 27.4%, daytime DBP - by 26.3%, nighttime DBP - by 18.5% (p=0.003). Perindopril decreased in number of non-dippers by 24,3% and night-peakers by 5.4% as well as increased in number of dippers by 27% and over-dippers by 2.7%. A number of patients with SAD profile corresponding to non-dipper type was 45.5% more in losartan taking than this when perindopril receiving (p=0.027). Conclusion. In patients with HT and stenotic coronary atherosclerosis perindopril therapy increases a number of patients with normal BP profile before myocardium revascularization.

306-312 394

Aim. To analyze costs of health care in Russia associated with smoking in 2009. Material and methods. Cardiovascular diseases, cancers and chronic obstructive pulmonary diseases (COPD) were included in the analysis. Calculation was performed on the basis of the relative risks of diseases associated with smoking, and obtained from foreign surveys, official statistics on morbidity and health system resources expenditure, and costs of health-seeking in line with state program of guaranteed free medical care.  Results. In 2009 total costs of the health care system associated with smoking exceeded RUR 35.8 bln. It corresponded to 0.1% of gross domestic product in Russia in 2009. The costs structure was the following: hospitalization – RUR 26.2 bln, emergency calls – RUR 1.4 bln, and outpatient health-seeking – RUR 8.2 bln. Costs of outpatient pharmacotherapy were not included into analysis because of lack of baseline data needed for calculations. Cardiovascular diseases caused 62% of the health care costs associated with smoking, cancers – 20.2%, and COPD – 17.8%. Conclusion. The smoking in Russia is associated with significant health care costs. It makes needed resources investment in preventive programs to reduce smoking prevalence.

313-318 585

Aim. To evaluate an effect of amlodipine on cognitive-mnestic functions (CMF) in able-bodied aged patients with essential arterial hypertension (EHT) with different degrees of blood pressure (BP) elevation. Material and Methods. CMF were studied in 97 patients with EAH aged 30-60 before and after antihypertensive therapy with amlodipine. Results. Revealed CMF changes corresponded to amnestic multifunctional type of mild cognitive impairments (R. Peterson, 2004) that is considered as a precursor of vascular dementia. Cognitive deficiency grade correlated positively with BP elevation degree: a total MMSE score is higher in patients with EHT 1 degree than this in patients with EHT 3 degree. Amlodipine therapy improved CMF: total MMSE score increased as well as scores according to “Attention” and “Memory” scales of MMSE. Conclusion. Monotherapy with calcium channels antagonist, amlodipine, improves CMF in patients with EAH. Amlodipine has positive effects on attention concentration and memory.

319-322 386

Aim. To study a rate of clopidogrel use in patients having indications for clopidogrel therapy according with up to date guidelines. Material and methods. Database of patients experienced acute myocardial infarction (MI) and database of patients experienced angiography because of stable ischemic heart disease (IHD) were used to evaluate clopidogrel therapy implementation. Patients with acute MI (n=84) and patients with IHD after angioplasty (n=239) were interviewed. Results. Only 14 of 84 (16.6%) patients after acute MI and 112 of 239 (47%) patients after angioplasty were taken clopidogrel within 12 months. Conclusion. The majority of patients after MI and coronary angioplasty do not receive clopidogrel despite the need of dual antiplatelet agents therapy.


323-333 423

Basic principles of the management of patients with atrial fibrillation (AF) are discussed taking into account recommendations of the European Society of Cardiology (2010). Peculiarities of AF diagnosis, clinical course and severity estimation, approaches to complications prevention and therapy strategy choice in patients with AF (rhythm control or heart rate control) are presented.

334-341 602

The main methods of viable myocardium diagnosis in patients with ischemic heart disease are discussed. Сurrent opportunities of stress echocardiography and tissue Doppler echocardiography in viable myocardium detection are presented.

342-346 426

Stroke secondary prevention in internist practice is discussed in accordance with up to date guidelines. Modern pharmacotherapy includes antiaggregants or anticoagulants, statins, and antihypertensive drugs. The choice of drugs is mostly founded on the rules of evidence based medicine, which allow adjusting individual treatment depending on clinical conditions. The composition of perindopril and indapamide is a preferred nowadays combination of antihypertensive drugs.


347-355 674

Possibilities of angina pectoris pharmacotherapy are analyzed. Achievement of target heart rate (HR) 55-60 beats per minute in these patients is possible due to three classes of antianginal medications that slow down HR: beta blockers (BB), If-channel inhibitors, nondihydropyridine calcium channel blockers (CCB). Nondihydropyridine CCB verapamil in slow release (SR) formulation is focused. The main results of randomized clinical trials (APSIS, VHAS, CRIS, EVERESTH, VAMPHYRE, INVEST, VESPA, DAVIT-1, DAVIT-2), which have proven efficacy and safety, are presented. Verapamil SR is indicated for the treatment of angina pectoris in patients without history of myocardial infarction (MI); angina patients experienced MI without systolic heart failure and with contraindications to BB; angina with arterial hypertension; left ventricular diastolic dysfunction; peripheral arteries obliterating atherosclerosis; silent myocardial ischemia; vasospastic angina; angina associated with supraventricular cardiac arrhythmias (especially in permanent atrial fibrillation) except Wolff-Parkinson-White and Lown-Ganong-Levine syndromes; after coronary angioplasty and the placement of bare metal stents.

356-364 908

Position of nifedipine in modern cardiology practice is highlighted. Nifedipine usage for arterial hypertension therapy , including combined one, stroke prevention, treatment of hypertensive crisis and ischemic heart disease is considered. Advantages of nifedipine innovative formulations are presented. Possible usage of nifedipine in pulmonary hypertension as well as pregnancy is discussed specially.

365-370 485

Statin intake is a standard in the treatment of patients with atherosclerosis nowadays. These drugs therapy associates with 30% risk reduction in mortality and coronary events. However , the threat of recurrent events is sufficiently high in large part of patients. This can be related to low level of high density lipoprotein cholesterol as well as elevated levels of triglycerides and lipoprotein(a). Nicotinic acid intake in these patients may be necessary for the normalization of lipid profile, including lipoprotein(a), and will be able to reduce residual cardiovascular risk. Evidence-based medicine data are presented to prove an efficacy of nicotinic acid in high doses in cardiology practice. Nicotinic acid both in monotherapy and in combination with statins contributes to coronary and carotid atherosclerosis regression and reduces an incidence of cardiovascular complications. Long-acting formulation of nicotinic acid, correct receiving regime and blood bio-chemical monitoring contribute to long-term safety of the drug in patients with clinically significant atherosclerosis.

382-386 455

Comparative dose-dependent ability of different statins to lower serum low-density lipoproteins (LDL) cholesterol was determined in three large meta-analysis. Besides, it was found that standardized decrease in LDL cholesterol levels on 1.0 or 1.8 mmol/l leads to rate reduction in ischemic heart disease acute episodes as well as stroke depending on treatment duration. Effect of LDL cholesterol reduction on stroke occurrence was more significant in studies, which included a major share of patients with vascular disease, because these patients have a higher risk of thromboembolic stroke (rather than haemorrhagic stroke) in comparison with the general population.



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