Rational Pharmacotherapy in Cardiology

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Vol 4, No 3 (2008)



6-16 542

Aim. To estimate a risk factor frequency of venous thromboembolism (VTE) in patients urgently hospitalized in hospitals, and also to estimate of patients part having effective prevention of VTE.

Material and methods. ENDORSE (Epidemiologic International Day for the Evaluation of Patients at Risk of Venous Thrombosis in Acute Hospital Care Setting) is the international register. Patients of 40 years and older hospitalised in therapeutic departments as well as patients of 18 years and older hospitalised in surgical departments (358 hospitals in 32 countries) were included in the register. The case history analysis of all patients was performed for estimation of risk VTE and evaluation of preventive therapy quality according to American College of Chest Physicians (ACCP) Recommendation 2004.

Results. Totally 68 183 patients (including 30 827 (45%) surgical patients and 37 356 (55%) therapeutic patients) were enrolled in Global ENDORSE Register. Russian centers enrolled 4 788 patients (including 2 829 (59%) surgical patients and 1 959 (41%) therapeutic patients). Totally 35 329 (51,8%) patients enrolled in Global ENDORSE Register (64,4% of surgical patients (19 842) and 41,5% of therapeutic patients (15 487)) had VTE risks. In Russia 2 188 enrolled patients (45,7%) had VTE risks (52% of surgical patients (1 470) and 36,7% of therapeutic patients (718). Totally 17 732 (50,2%) patients enrolled in Global Register ENDORSE and having VTE risks received VTE preventive therapy according to АССР Recommendations 2004. In Russia 521 (23,8%) patients enrolled in Global ENDORSE Register and having VTE risks received VTE preventive therapy according to АССР Recommendations 2004. It is more than 2 times less in comparison with world level (р<0.001).

Conclusion. There are a lot of patients with VTE risks in hospitals. It is necessary to improve preventive therapy of VTE due to better hospital management and more active use of АССР Recommendations 2004.

19-25 9227

Aim. To compare clinical and haemodynamic efficacy of ramipril vs enalapril in women with chronic heart failure (CHF).

Material and methods. 60 women with non valvular CHF were included in the study. Patients were randomized in groups of ramipril or enalapril taken in addition to standard therapy. CHF severity, heart morphofunctional parameters, life quality, exercise tolerance, biomarkers (brain natriuretic peptide, von Willebrand factor) was estimated in patients initially and after 6 months of therapy.

Results. Ramipril average daily dose was 11,4 mg, enalapril average daily dose - 34,2 mg. Dry cough was observed more rarely in patients treated with ramipril than in patients treated with enalapril. There was a trend to higher increase of exercise tolerance due to ramipril therapy in comparison with enalapril one (р=0,062). Ramipril, but not enalapril, reduced a number of patients with diastolic dysfunction (р=0,049). Life quality improvement was higher in ramipril treated patients in comparison with those treated with enalapril (р=0,04). Brain natriuretic peptide and von Willebrand factor levels decreased more significantly in ramipril therapy than in enalapril one (р=0,05 and р<0,05 , respectively).

Conclusion. Ramipril therapy of CHF in women has higher clinical efficacy and better tolerability in comparison with enalapril therapy.

26-30 477

Aim. To estimate an efficacy of therapy with ω-3 polyunsaturated fatty acids (PUFA) in patients with ischemic heart disease (IHD) before and after coronary artery bypass graft (CABG).

Material and methods. 189 patients (125 men, 64 women; aged 64,2±9,4 y.o.) with IHD having indications to CABG were enrolled in the study. Patients of the first group (control) had standard pre- and postoperative treatment. Patients of the second group received ω-3 PUFA (ОМАCОR, Solvay Pharma) 2 g/daily in addition to standard therapy. Both groups were similar in clinical characteristics. ω-3 PUFA therapy started 7±4 day before CABG, renewed in early postoperative period (24-36 hours after surgery) and lasted next 14 days. Efficacy of the therapy was estimated by atrial fibrillation frequency in postoperative period and time before hospital discharge after CABG. An automatic complex for transesophageal electrophysiological cardiac examination was used for the estimation of atrial conduction before and after CABG.

Results. Omacor therapy in patients with ICD before CABG and in the early postoperative period reduces atrial fibrillation risk. It results in reduction of hemodynamic disorders and time before hospital discharge. Conclusion. Omacor therapy is safe and can be recommended to all patients going through CABG.

33-38 538

Aim. To evaluate the heart rate variability (HRV) in patients with ischemic heart disease (IHD) and paroxysmal atrial fibrillation (AF) during atorvastatin therapy.

Material and methods. 60 patients with IHD and paroxysmal AF were included in the study. Patients were divided into two groups – control group (basic antiarrhythmic therapy) and second group (basic antiarrhythmic therapy and atorvastatin (Liptonorm, Pharmstandart, Russia) 10mg/day). HRV was compared before and after 3 months of therapy in both groups.

Results. Liptonorm significantly improved HRV indices in comparison with basic therapy alone: RMSSD increased on 33% (р <0,02), total power (TP) of spectrum on 28% (р <0,03) and high frequency (HF) component on 53 % (р <0,01).

Conclusion. Liptonorm therapy improves autonomic balance in patients with IHD and paroxysmal AF.

39-44 607

Aim. To study clinical equivalence of original (DilatrendR, ≪Hoffmann-La Roche≫, Switzerland) and of generic (VedicardolR, ≪Synthesis≫, Russia) carvedilols with estimation of their serum level. And to study pharmacoeconomic advantages of their usage in patients with arterial hypertension (HT) of 1-2 stages.

Material and methods. Study was double blind, randomized, crossed. 30 patients (8 men and 22 women, 57 y.o. average) with HT of 1 stage (3,3 %) and 2 stage (96,7 %) were included in the study. Original or generic carvedilols (12,5 mg twice a day) were prescribed to the patients. Hydrochlorothiazide was added followed carvedilol dose enlargement if initial antihypertensive effect had been insufficient. The second similar course of therapy with other carvedilol took place in 2 weeks after cancellation of the first carvedilol. Carvedilol serum level, blood pressure (BP), heart rate (HR) and side effects were registered on each visit.

Results. 75 % of Vedikardol-group patients and 75 % of Dilatrend-group patients had reached target BP level (<140/90 mm Hg). Monotherapy was effective more than in a half of patients in both groups. Dilatrend had more expressed influence on HR in comparison with Vedikardol. Both drugs did not differ significantly in frequency and intensity of side effects.

Conclusion. Generic carvedilol (VedicardolR) has clinical efficiency and pharmacokinetics similar to these of original carvedilol (DilatrendR). Generic carvedilol has lower cost of treatment than this in original carvedilol.

47-51 1204

Aim. To evaluate an influence of carvedilol on risk of hypoglycemia in patients with diabetes type 2 (D2) and chronic heart failure (CHF) treated with angiotensin converting enzyme (ACE) inhibitors.

Material and methods. 13 patients (10 men, 3 women; aged 59,8±6,7 y.o.) with D2 and CHF caused by ischemic heart disease were included in the study. Before inclusion all patients were treated with ACE inhibitors and various beta-blockers (atenolol, metoprolol, bisoprolol). These beta-blockers were changed for carvedilol. Heart ultrasonography, blood pressure control, glycemia monitoring, HbA1c level determination were performed before, during and after carvedilol therapy.

Results. Carvedilol reduces frequency and duration of hypoglycaemia episodes. There were not episodes of severe hypoglycaemia during carvedilol therapy.

Conclusion. Carvedilol reduces risk of hypoglycemia when it is used in combination with ACE inhiditors in diabetic patients with CHF.

52-58 824

Aim. To compare effects of enalapril in combination with long-acting nifedipine or moxonidine on blood pressure (BP), myocardial mass and diastolic function of left ventricular, lipid and carbohydrate metabolism, platelet aggregation in patients with arterial hypertension (HT) and metabolic syndrome (MS).

Material and methods. 50 patients with HT and MS were examined. 25 patients were treated with enalapril and long-acting nifedipine and 25 patients – with enalapril and moxonidine. 24-hour BP monitoring, echocardiography, anthropometry, lipid and carbohydrate metabolism estimation, platelet aggregation testing were performed before and 6 months after treatment.

Results. Both combinations allowed to achieve target BP levels, provided cardioprotective and positive metabolic effects in most patients. The combination of enalapril and long-acting nifedipine had more significant antihypertensive effect and more prominently decreased the platelet aggregation induced by collagen. The combination of enalapril and moxonidine had more significant positive effects on carbohydrate metabolism and ADP-induced platelet aggregation.

Conclusion. Enalapril in combination with long-acting nifedipine or moxonidine can be recommended for treatment of patients with HT and MS.

59-64 468

Aim. To study influence of patient training in Health School on pharmacotherapy profile and cost in patients with ischemic heart disease (IHD).

Material and methods. 100 out-patients with IHD (stable angina pectoris) were involved in the study and divided in two groups. Patients of preventive group were trained in Health School. Control group included untrained patients (typical practice). All patients were observed during 12 months.

Results. ABC/VEN pharmacotherapy analysis showed inadequate hypolipidemic therapy and irrational antianginal therapy 12 months before study. Cost of treatment was unreasonably high because of active application of long-acting nitroglycerine and insufficient use of antianginal drugs corresponding to current evidence based recommendations (ex., beta-blockers). Improvement of pharmacotherapy profile and cost was observed in preventive group after Health School training due to increase of hypolipidemic drug and beta-blocker application and reduction of nitroglycerine consumption. There were not any changes of pharmacotherapy profile and cost in control group.

Conclusion. Health School for patients is effective tool to improve IHD pharmacotherapy profile and cost. АВС/VEN analysis is relevant method for estimation of pharmacotherapy profile and cost in patients with IHD.


65-71 11725

Aim. To compare urodynamic effects of beta-blockers with different selectivity (propranolol, metoprolol, nebivolol) in patients with arterial hypertension (HT) and concomitant benign prostatic hyperplasia (BPH).

Material and methods. 32 patients (aged 67,5 y.o. in average) with HT of 1-2 stages were involved in the study. All patients had BPH (prostate volume >40 sm3 , increase of residual urine volume) with moderate or severe low urinary tract symptoms (IPSS 8-25) and reduction of maximum urine flow rate to 5-13 ml/s. The urodynamic effect of beta-blockers was estimated by changes of urination frequency and uroflowmetry indices after single taking and 14-day therapy.

Results. Propranolol and metoprolol led to aggravation of urination disorders. Nebivolol resulted in soft urodilating and urostimulating effects. It led to urination improvement and reduced a risk of urodynamic disorders.

Conclusion. Urodynamic effects of cardiovascular drugs should be considered by practitioners especially in treatment of elderly patients.

72-75 593
Connective tissue dysplasia (CTD) represents special ontogenetic abnormality which is a complex problem of contemporary medicine. The principles of differential diagnosis of various forms of CTD are considered. A clinical estimation and therapy approaches are discussed with focus on hypermobility syndrome as one of undifferentiated form of CTD.
76-82 607

Aim. To assess influence of combined antihypertensive (captopril or metoprolol) and antidepressant (thianeptin or sertralin) therapy on clinical status, blood pressure (BP) and myocardial function in patients with arterial hypertension (HT) and affective disorders (AD).

Material and methods. 106 patients with HT were involved in the study. 64 patients (60,4%) had concomitant AD. All patients were divided into 3 groups. 46 patients with HT and AD were included in the 1-st group. They received metoprolol or captopril in combination with tianeptine or sertaline. The 2-nd group included 18 patients with HT and AD who received only antihypertensive therapy. The 3-rd group consisted of 42 patients with HT without AD. They also received only antihypertensive therapy.

Results. After 6 month therapy patients of the 1-st and the 3-rd groups had more significant clinical improvement and BP reduction (according to 24- hour BP monitoring) as well as more farourable structural and functional changes of left ventricular in comparison with patients of the 2-nd group.

Conclusion. In patients with HT and concomitant AD combined antihypertensive and antidepressant therapy result in favourable clinical changes, effectively reduce BP, improve left ventricular structure and function.

83-88 452
The problem of anxiety and depression in internal medicine is discussed. Diagnosis of these disorders in general practitioner every day practice is surveyed. Possibilities of anxiety and depression treatment are highlight. Modern psychopharmacotherapy is focused, especially antidepressants usage.


91-100 469
Possibilities of modern antiplatelet and antithrombotic therapy at percutaneous coronary interventions in patients with coronary artery disease are surveyed. Data of multicenter randomized clinical trials and meta-analyses are discussed. Possibilities of various drugs at percutaneous coronary interventions are reported from position of the international clinical guidelines.
101-104 519
The beta-blocker role in arterial hypertension treatment is surveyed from the positions of evidence based medicine and international clinical guidelines. Data of last randomized clinical trials and meta-analyses are discussed.
105-110 3125
The role of angiotensin II in pathogenesis of cardiovascular diseases is discussed. Angiotensin II participates in development of acute myocardial infarction (MI) in patients with atherosclerosis. It contributes to inflammation of vessel intimae, oxidative stress, cells apoptosis, matrix remodeling, has pro-thrombosis action, promotes MI expansion and post-MI remodeling. Angiotensin converting enzyme (ACE) inhibitors reduce mortality and improve prognosis of patients with acute MI. In patients with ischemic heart disease including patients after MI ACE inhibitors reduce mortality, risk of repeated MI as well as improve quality of life.



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