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Rational Pharmacotherapy in Cardiology

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Vol 5, No 3 (2009)
View or download the full issue PDF (Russian)
https://doi.org/10.20996/1819-6446-2009-5-3

 
4-7 144
Abstract

In the issue.

ANALYSIS OF CLINICAL PRACTICE

8-13 268
Abstract

Aim. To evaluate cardiovascular diseases (CVD) treatment in patients with type 2 diabetes mellitus (DM 2) in current clinical practice.

Material and methods. A total of 200 patients with DM 2, who consented to take part in the questionnaire, were examined. Questionnaire, clinical and laboratory examinations were conducted.

Results. There was a low frequency of CVD recognized and included into clinical diagnosis – angina, history of myocardial infarction and stroke. In majority of the patients decompensated carbohydrate metabolism was observed. This was due to lack of knowledge, inadequate or absent glucose self-monitoring, low frequency of combined glucoselowering therapy. Target level of blood pressure (BP) was registered in 16% of hypertensive patients only. Basic reasons of this were: frequently prescribed mono-therapy, irrational combinations, inadequate dosage and frequent omissions of antihypertensive drugs intake and not appropriate BP self-monitoring. Low frequency of statins therapy and non-targeted cholesterol levels were also revealed in examined patients.

Conclusion. Improvement of diagnostic tactics in patients with DM 2 is necessary as well as therapy correction taking into account these patients co-morbidity.

ORIGINAL STUDIES

14-18 316
Abstract

Aim. To evaluate parameters of arterial stiffness by non-invasive arteriography in patients with moderate/high cardiovascular risk receiving lisinopril and simvastatin.

Material and methods. 20 patients (aged 50-55 y.o.) with arterial hypertension of the 1st degree and dislipidemia are included in the study. All patients had pulse wave velocity (PWV) ≥ 10 m/s and/or the corrected index of pulse wave augmentation (AI × 80) ≥ -10% according to non-invasive arteriography data; and moderate-high cardiovascular risk (≥ 3%). Patients received therapy with lisinopril and simvastatin. Blood pressure (BP) levels and lipid profiles were assessed before therapy and in 1, 2, 6 and 12 month of the observation. Non-invasive arteriography was performed before therapy and in 2, 6 and 12 months later.

Results. BP target levels were reached within 1 month of treatment as well as improvement of lipid profile was reached within 2 months in majority of the patients. Reference PWV and AI were reached in 85,7% of patients within one year of treatment.

Conclusion. Arterial stiffness parameters help to evaluate cardiovascular risk changes accurately as the results of treatment.
19-24 357
Abstract

Aim. To study efficacy and safety of beta-blocker with vasodilating properties carvedilol (Acridilole, Akrihin, Russia) as a part of the combined therapy of patients with arterial hypertension (HT) and diabetes mellitus 2 type (DM2) and/or obesity.

Material and methods. 592 patients: 176 men (29,7%) and 416 women (70,3%) with HT were examined. 194 patients had D2 and 398 patients had obesity. Patients were randomized for carvedilol therapy (n=291) or control group (n=301). Carvedilol was prescribed additionally to current therapy in dose of 6,25 mg BID, in 2 weeks the dose was increased to 12,5 mg BID if it was necessary. Blood pressure (BP) and heart rate, number of angina attacks were registered at visits. ECG, laboratory analysis (plasma lipide profile, serum glucose, glycolised haemoglobin, serum K+ and Na+), evaluation of depression and anxiety status (according to special questionnaires) were performed on the first and the last visits.

Results. 582 patients completed the study. 7 patients dropped out from carvedilol group and 3 patients - from control group. The levels of systolic BP (SBP) and diastolic BP (DBP) were decreased during study, more significantly in carvedilol group (р<0,0001). SBP decreased on 24,8 mm Hg in patients of carvedilol group and on 21,4 mm Hg in patients of control group. DBP decreased on 12,5 mm Hg and 11 mm Hg respectively. Angina attacks were registered less often in patients of carvedilol group (р=0,001). Serum glucose and lipid spectrum did not change in both groups. Depression level decreased in patients receiving carvedilol. 17 side effects were registered in carvedilol group and 15 - in control group (р=0,575)

Conclusion. High antihypertensive efficacy of carvedilol is confirmed in hypertensive patients with DM2 and/or obesity. Good tolerability and metabolic neutrality of carvedilol is also observed.

25-30 353
Abstract

Aim. To study erectile dysfunction prevalence among out-patients with arterial hypertension (HT) and/or coronary heart disease (CHD) as well as to study risk factors of erectile dysfunction.

Material and methods. The anonymous poll was carried out among 103 male patients with HT and/or CHD. General information about patient, medical history, treatment was analyzed. All patients were examined by cardiologists. Erectile function was assessed with The International Index Erectile Function (IIEF) questionnaire.

Results. 86 (84%) questionnaires were returned. 62 (72%) patients from 86 responding had erectile dysfunction. Age, blood pressure level, abdominal obesity, beta-blocker therapy and chronic heart failure affected erectile function.

Conclusion. The erectile dysfunction was common disorder among male patients with HT and/or CHD. Early erectile dysfunction diagnosis, prevention and therapy are necessary to provide high level of compliance in patients with cardiovascular diseases.

31-35 887
Abstract

Aim. To compare ivabradine (IB) and verapamil (VP) effects on left ventricle (LV) diastolic function in patients with diastolic heart failure (DHF) caused by left ventricle impaired relaxation.

Methods. It was comparative randomized study. 238 patients (190 men, 48 women; aged 63±10 y.o.) with DHF were randomized in two groups to receive IB (7,5 mg bid, n=119) or VP (240 mg o.d., n=119). Echocardiography (EchoCG) indices, total ischemic burden (TIB) and N-terminal fragment of pro-brain natriuretic peptide (NT-pro-BNP) were eval￾uated initially and after 1, 3, 6 and 12 months of therapy.

Results. After 3 months of therapy some EchoCG parameters (E/A, transmitral E wave deceleration time [EDT]) as well as TIB improved more significantly in IB group. After 6 months in IB group in comparison with VP group additional differences appeared (midwall fractional shortening; E/Em of lateral mitral annulus – 8,6±4,7 and 12,3±4,7, respectively, p<0,05; NT-pro-BNP – 91,7±4,3 pg/ml and 128±7,6 pg/ml, respectively, p<0.01) or became stronger (TIB, E/A and EDT). The differences persisted after 12 months of follow up. Besides a number of patients required hospitalization were less in IB group in comparison with VP group (11 vs 19, respectively, p<0.05).

Conclusion. Both IB and VP improved diastolic function and reduced heart rate, ischemia time, NT-pro-BNP levels and hospitalization rate in patients with DHF. However, IB com￾pared with VP has more prominent effect on these parameters. 

36-41 227
Abstract

Aim. To study clinical and economical rationales for cardiovascular risk evaluation at workplace (on example of the personnel of engineering research institute).

Material and methods. Complex preventive screening with evaluation of arterial hypertension (HT) prevalence, cardiovascular risk level and requirement for risk factors correction is performed. Economical rationales for preventive screening (with estimation of the total costs, costs for one studied person and costs for revealing of one person needed in preventive actions) are also estimated.

Results. Preventive screening in the organized collective found new HT cases (12,2%), high and very high cardiovascular risk (58,6%). The desire for risk factors correction is found in 13,0-59,0% of workers. The total costs for preventive screening of 468 persons were 174413 rubles in 3,5 months. Costs for examination of one worker were 561,7 rubles. Costs for detecting of one worker requiring preventive actions were from 635,6 to 3077,4 rubles

Conclusion. There are rationales for preventive screening of cardiovascular risk and desire to correct it at the workplace. 

42-45 286
Abstract

Aim. To compare effects of eprosartan and enalapril on free-radical oxidation in patients with acute myocardial infarction (AMI) without Q wave.

Material and methods. 50 patients (aged 52,8±3,3 y.o.) with AMI without Q were involved into the study. Patients were randomized on 2 groups. The first group consisted of 24 patients (51,1±2,4 y.o.) which received basic therapy and enalapril (10 mg daily). The second group consisted of 26 patients (53,1±3,0 y.o.) which received basic therapy and eprosartan (600 mg daily). Basic therapy included anticoagulants, antiplatelets, beta-blockers, nitrates and statins. Intensity of free-radical oxidation was evaluated by change of serum malonic dialdehyde (MDD) concentration. Functional activity of serum enzymes of antioxidatic system (AOS) was evaluated by rate of reaction of superoxide dismutase (SOD) and catalase (CT).

Results. The intensity of free-radical oxidation increased in patients with AMI without Q: high level of MDD and peroxinitrite (ONOO-). Besides activity of AOS enzymes (SOD and CT) decreased. Eprosartan reduced intensity of peroxide oxidation more prominently in comparison with enalapril. Both drugs preserved low activity of SOD and CT.

Conclusion. Eprosartan was significantly more effective than enalapril in reduction of serum free-radical oxidation in patients with AMI without Q wave during 10 days after hospital admission.

46-50 387
Abstract

Aim. To compare effect of percutaneous balloon angioplasty (PCA) and a systemic thrombolysis (STL) on the central and intracardiac hemodynamics in patients with acute coronary syndrome (ACS) with ST segment elevation.

Material and methods. 80 patients with ACS with ST segment elevation were included in the study. Patients were split into 2 groups depending on reperfusion strategy. PCA was performed in 55 patients (first group). 25 patients of the second group had STL with Streptokinase, i/v, 1 500 000 units per hour. Echocardiography was performed in all patients at admission and after 3 and 7 days of treatment to evaluate intracardiac hemodynamics.

Results. Both reperfusion methods significantly increase of ejection fraction (EF) and maximal output speed of left ventricle (LV). Increase of LV EF in patients after PCA was higher than this in patients after STL. PCA improved LV diastolic function; STL did not change this characteristic. After PCA working diagnosis of ACS was transformed to the following final diagnosis: acute myocardial infarction (AMI) with Q, AMI without Q and unstable angina in 37,5, 30,4 and 32,1% of patients, respectively. After STL diagnosis of AMI with Q was defined in all patients.

Conclusion. PCA in patients with ACS with ST segment elevation results in fast improvement of global systolic and diastolic LV function. Besides, PCA prevents AMI with Q in a half of these patients.

51-54 359
Abstract

Aim. To study a rate of resistance to acetylsalicylic acid (ASA) and clopidogrel and clinical outcomes in patients with atherosclerosis and diabetes mellitus type 2 (DM2).

Material and methods. 154 patients were involved in the study and split into two groups. 100 patients (47 men, 53 women; aged 66,4±7,8 y.o.) with ischemic heart disease (IHD) (which was presented by angina pectoris, class I-III, or myocardial infarction history) were included into the first group (G1). Other 54 patients (38 men, 16 women; aged 64,1±10,2 y.o.) with IHD associated with obliterative atherosclerosis of lower limb were included into the 2nd group (G2). Platelet aggregation was evaluated by Born's method (inducers of platelet aggregation were arachidonic acid and ADP). Reduction of platelet aggregation ≥20% after arachidonic acid induction was considered as criterion of re￾sistance to ASA. Patients were considered as resistant, partly resistant and sensitive to clopidogrel if platelet aggregation reduced on <10%, 10-29%, and ≥30% respectively.

Results. Rate of ASA and clopidogrel resistance in patients with DM2 was significantly higher than these in patients without DM2 (48% vs 16% respectively, р=0,003 in G1; 42% vs 7% respectively, р=0,007 in G2).

Conclusion. Resistance to antiplatelet drugs is observed more often in patients with DM2 and can result in increased risk of cardiovascular complications.

55-61 306
Abstract

Aim. To study effects of carvedilol and metoprolol on vegetative regulation of heart and microcirculatory vessels in patients with arterial hypertension (HT) of 1-2 degrees and high body mass/obesity.

Material and methods. Patients with HT of 1-2 degrees (n=25; aged 51±8 y.o.) were included in the study. Registration of 0,1 Hz-fluctuations in heart rhythm variability and microcirculation change was performed during passive orthostatic test at spontaneous breath (duration of each test stage 10 min). Synchronization of 0,1 Hz-rhythms was estimated by calculation of phases difference and a numerical measure of synchronization. Frequency estimations of heart rhythm variability spectrum were performed in high and low frequency ranges additionaly.

Results. Carvedilol and metoprolol have the comparable antihypertensive effect and influence on vegetative regulation of cardiovascular system in patients with HT. Both drugs have negative influence on synchronization of 0,1 Hz-rhythms in initially high systolic blood pressure level (>150 mm Hg).

Conclusion. Carvedilol and metoprolol have comparable influence on synchronization of 0,1 Hz-rhythms in cardiovascular system.

62-66 695
Abstract

Aim. To assess a risk of vascular embolism in patients with ischemic heart disease (IHD) and hemodynamic insignificant asymptomatic carotid stenosis.

Material and methods. 100 patients with IHD were examined. Ultrasound scanning of the main cranial arteries and transcranial Dopplerography was performed in all patients as well as lipid spectrum, fibrinogen level and blood D-diameter concentration were evaluated.

Results. 165 carotid atherosclerotic plaques (AP) were detected in patients with IHD independently on angina severity. In IHD patients with nonhomogeneous hypoechogenic AP microembolic signals (MES) were revealed in 44,78%, with nonhomogeneous hyperechogenic AP - in 25%, with homogeneous hypoechogenic AP - in 4,16% of patients. MES were not recorded in patients with homogeneous hyperechogenic AP. There were not relations between MES and parameters of lipid spectrum as well as fibrinogen and Ddiameter plasma levels.

Conclusion. Thus, during transcranial dopplerographic monitoring MES were recorded in the third part (27,9%) of IHD patients with hemodynamically insignificant carotid arteries stenosis. MES were predominantly observed in patients with nonhomogeneous AP especially with hypoechogenic components.

ASSOCIATED PROBLEMS OF CARDIOLOGY

67-70 337
Abstract

Aim. To study a prevalence and peculiarities arterial hypertension (HT) in patients with rheumatoid arthritis (RA).

Patients and methods. 584 patients with RA were involved in the study. RA was diagnosed according to ACR criteria (1987).

Results. 58,6% of the patients with RA had HT. It is significantly more often than this in common population. HT prevalence was directly related with RA duration and RA activity.

Conclusion. High HT prevalence in patients with RA and fast growth of morbidity at the beginning of RA requires accurate blood pressure control for HT early diagnosis and timely therapy. Taking into account wide usage of non steroid antiinflammatory drugs calcium antagonists or angiotensin II receptor antagonists are more preferable in this group of patients. 

CURRENT QUESTIONS OF CLINICAL PHARMACOLOGY

71-75 347
Abstract

Clinical efficacy of unfractionated and low molecular heparins in acute coronary syndrome is discussed. New synthetic heparin derivative fondaparinux (Arixtra) is focused. Author’s brief experience of fondaparinux clinical implementation is presented.

POINT OF VIEW

76-82 288
Abstract

The implementation of contemporary ambulatory methods of BP level evaluation in clinical practice improved diagnostics of arterial hypertension (HT), but at the same time faced with specific problems. White coat HT (WCHT) and masked HT are characterized by inconsistency between ambulatory and clinical BP levels. Studying of these conditions in patients receiving antihypertensive therapy is important. The WCHT during treatment (target ambulatory BP levels and no control of clinical BP) is observed in 10-20% of patients. The cardiovascular risk in these patients does not differ significantly from the risk in patients with controlled BP. Masked HT (target levels of clinical BP and no control of ambulatory BP) is observed in 5,4-23% of patients. The cardiovascular risk in patients with masked HT is 2,5-3,0 times more than that in patients with controlled HT and comparable with risk in patients with ineffective antihypertensive therapy. Thus, clinical measurements can give inexact data about true BP level in one third of treated hypertensive patients. Therefore the evaluation of cardiovascular risk and correct usage of ambulatory BP measurement is important for choice of therapy tactics in patients with HT. 

83-88 414
Abstract

The role of ACE inhibitors in modern pharmacotherapy of patients with chronic heart failure (CHF) is discussed. The actual usage of these highly effective drugs is underlined taking into account high prevalence and social significance of CHF. Necessity of ACE inhibitors usage is confirmed by pharmacodynamic features of these drugs in CHF. The special attention is given to enalapril, that has the biggest evidence base in treatment of CHF patients.

89-94 288
Abstract

The safety of anticoagulant therapy is discussed. Warfarin position in prevention of thrombotic complications is analyzed according to the evidence base medicine approach. Possible hemorrhagic complications of warfarin are described and accompanied with clinical cases. Possibility of renewal of anticoagulant therapy in patients after hemorrhagic complications is discussed.

THERAPY GUIDELINES

JUBILEE

123-124 268
Abstract

Academician E.I. Chazov – 80 years old.

125-127 161
Abstract

The best cardiologist of Russia have got the prize “Purple Heart”.



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