Rational Pharmacotherapy in Cardiology

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Vol 14, No 1 (2018)
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4-11 706

 Aim. To conduct a comparative study of the changes in blood lipids profiles in populations of the Russian Federation (RF) and the United States of America (USA) in different age and gender groups over the period from 1975 to 2014.

Material and methods. Using a secondary analysis of data obtained from the RF population studies carried out in 1975-1982, the multicenter epidemiological study of cardiovascular diseases in different regions of the RF (ESSE-RF), conducted in 2012-2014, as well as the NHANES series of crosssectional surveys in the civilian non-institutionalized population of the USA (NHANES II in 1976-1980 and Continuous NHANES in 2007-2012), we evaluated average lipids in blood tests in men and women of different age groups, with a total number of 48,974 observations.

Results. At present, in the RF population, as compared to the USA one, most age groups demonstrate a higher concentration of total cholesterol, i.e. p<0.05 in all groups except for men aged 25-34 years (distinctions are absent) and women aged 25-34 (the concentrations are lower in Russia, p=0.05); a higher concentration of high-density lipoprotein cholesterol, i.e. p<0.005 in all men and p≤0.05 in women younger than 45 years, while in women aged 45-54 years the differences are non-significant; in 55-64-year-old women high-density lipoprotein cholesterol is higher in the USA; the concentration of triglycerides in Russia is lower in comparison with the USA in all age groups of men and women (p<0.01). Over the three decades, the total cholesterol concentration has declined in both countries; the patterns in theUnited States in comparison withRussia are characterized by an increase in the concentration of high-density lipoprotein cholesterol in all age groups and by the absence of a negative trend in triglyceride concentrations.

Conclusion. Currently, inRussia, the total cholesterol and low-density lipoprotein cholesterol levels are worse, while triglycerides and partly high-density lipoprotein cholesterol concentrations are better than in theUSA. In general, the thirty-year trends for the aggregate of lipid metabolism parameters are better in theUSA population as compared toRussia. 

12-20 834

Aim. To study the efficacy and safety of the use of hydrochlorothiazide/losartan or amlodipine/losartan fixed combinations in patients with arterial hypertension (HT) in real clinical practice.

Material and methods. A total of 13,863 adult patients with HT were enrolled into the observational study. One month ago, according to the indications, they were prescribed therapy with amlodipine/losartan (5/50, 10/50, 5/100, 10/100 mg) or hydrochlorothiazide/losartan (12.5/50, 12.5/100, 25/100 mg). The study included only those patients who did not reach the target blood pressure (BP) level in previous therapy, or were not treated earlier. The study duration was 3 months.

Results. 79.17% of patients reached the target BP level by the end of the study after 3 months. High efficacy of HT treatment persisted in concomitant diseases. The target BP level was achieved in 76.42% of patients with coronary heart disease, 73.98% of patients with diabetes and 78.34% of patients with chronic obstructive pulmonary disease. According to the results of the questionnaire on a 7-point scale, 93% of doctors gave the maximum score on the treatment effectiveness and 97% – on the treatment safety. During the entire treatment period, no one patient discontinued participation in the study due to adverse events.

 Conclusion. The study demonstrated high efficacy and safety of HT patients treatment with hydrochlorothiazide/losartan and amlodipine/losartan fixed combinations in real clinical practice. The majority of patients who were previously treated ineffectively or did not receive treatment achieved adequate BP control during treatment with hydrochlorothiazide/losartan or amlodipine/losartan fixed combinations. 

21-26 702

Aim. To compare features of pharmacotherapy of patients with chronic heart failure (CHF) with a reduced ejection fraction of the left ventricle (LV EF) who were admitted in a specialized department of the multidisciplinary hospital in Saratov before and after the publication of the Russian National Recommendations (4 revision) on the diagnosis and treatment of CHF (2012).

 Material and methods. A pharmacoepidemiological retrospective study was conducted. The object of the study was the medical records of inpatients (form 003/y) with the diagnosis "Heart failure" (ICD-I50), that consecutively admitted to the cardiology department of the multidisciplinary hospital in Saratov from April 28, 2009 to January 19, 2010 (n=52) and from February 19, 2014 to May 20, 2015 (n=95). Patients over 18 years of age with diagnosis of CHF (NYHA II-IV) and LV EF <45% were enrolled into the analysis. For each patient, an individual registration card was filled in which the patient's clinical and demographic characteristics, prescribed medications, their daily dose, the frequency of administration, the route of administration were indicated. Pharmacoepidemiological analysis was carried out for the drugs prescribed at the 1st day of hospitalization, at the 3rd-6th day (the time of stabilization of the patient's condition, which was evaluated by the reduction in dyspnea and increase in the tolerance to physical loads). The recommendations given by the physicians at discharge of the patients from the hospital were also considered.

 Results. In 2014-2015 years, compared to 2009-2010 years, the number of identified arrhythmias and severe forms of arterial hypertension significantly (82.1 vs 77%; р<0.05) increased. In 2014-2015 the frequency of the prescriptions of ACE inhibitors decreased (77.8 vs 86.5%; p<0.05). The frequency of the prescriptions of angiotensin II receptor blockers, antagonists of mineralocorticoid receptors (AMCR), diuretics, oral anticoagulants, clopidogrel increased (p<0.05). In the structure of combination therapy in 2014-2015, the frequency of the prescription of the ACE inhibitor+beta-blocker and ACE inhibitor+beta-adrenoblocker+AMCR combinations decreased significantly (18.9 vs 26.9%, p<0.05 and 22.1 vs 42.3%, p<0.05, respectively). At the same time prescription frequency of the ACE inhibitor+beta-blocker+AMCR+diuretic combination increased (25.2 vs 11.5%, p<0.05).

 Conclusion. Pharmacotherapy of CHF in hospital in 2014-2015 is consistent with the Russian National Recommendations (4 revision) and is significantly different from the CHF therapy in 2009-2010. Keywords: pharmacoepidemiology, chronic heart failure, treatment. 

27-33 578

Aim. To study serum level of leptin in patients with the metabolic syndrome (MS), including in patients with MS in combination with left ventricular hypertrophy (LVH) to determine the diagnostic significance of this marker in MS.

Material and methods. The study involved 43 patients with MS, 33 of them with signs of LVH, and 33 patients without MS comparable age, including 10 patients with LVH. The average age of patients in the MS group at the time of inclusion into the study was 62.7±10.3 years, in the control group (without MS) – 60±14.7 years. All patients underwent a comprehensive examination that included the collection of complaints, study of history, physical examination, anthropometric measurements, laboratory and instrumental examination, including study of the serum level of leptin.

Results. Patients of both groups had statistically significant differences in the size of the heart chambers, the presence of LVH signs, left ventricle contractile function, the thickness of the epicardial fat layer. Thus, enlargement of the heart, thickness of the interventricular septum, posterior wall of the left ventricle, thickness of epicardial fat, reduction of ejection fraction of the left ventricle and characteristics of aortic atherosclerosis were observed significantly more often in patients with MS compared with the group without MS (p<0.05).The average serum level of leptin in the MS group (41.89±33.28 ng/ml) was significantly higher compared to the group without MS (17.64±16.87 ng/ml), p<0.001. At that women had significantly higher levels of serum leptin (38.65±29.23 ng/ml) compared to males (19.54±27.23 ng/ml), p=0.006. A positive correlation between leptin levels and symptoms of LVH (r=0.294, p<0.001) was revealed: in the absence of LVH average level of leptin was 21.7±4.1 ng/ml, in the presence of signs of LVH – 39.2±4.95 ng/ml.

Conclusions. Leptin levels in MS patients is higher than in patients without MS, and in patients with MS associated with LVH is higher than in MS patients without LVH. As the leptin level increases, the risk of LVH increases.

34-39 1030

Aim. To study the therapeutic efficacy and safety of generic drug of ivabradine in comparison with the original drug in patients with stable angina. Material and methods. Patients with stable angina of II-III functional class (n=20) were included into an open randomized pilot study with a crosssectional design. Inclusion criterion: heart rate >70 beats/min during the use of beta-blockers. The comorbid cardiac pathology was represented by arterial hypertension of 1-3 degrees and chronic heart failure of I-III functional class. Initially, all patients underwent a clinical examination. Patients were randomized into the Group 1 receiving the original (Coraxan®, Servier,Serdix,Russia) or Group 2 receiving generic (Raenom®,Gedeon Richter,Hungary) drug of ivabradine (in addition to ongoing therapy), 5 mg BID. During the following month, the patients were monitored weekly. If necessary, the doses of the studied drugs were adjusted to achieve the target values of clinical indicators. After 4 weeks of therapy, study drugs in groups were replaced in equivalent doses; patients were observed for another 4 weeks.

Results. A statistically significant decrease in heart rate (from 82.5±6.63 to 66.3±6.18 beats/minute in Group 1 and from 83.0±6.18 to 67.6±5.97 beats/min in the 2nd group, p<0.01 for both) and in blood pressure level was found in groups during the first 4 weeks of follow-up. Besides, there was a reduction in a number of weekly anginal attacks (76.1%, p<0.01) and sublingual nitroglycerin tablets (78.0%, p<0.01) in Group 1 as well as in Group 2 (75.2%, p<0.01 and 76.7%, p<0.01), respectively. The average daily dose of ivabradine in patients of the first group was 10 mg, in patients of the second group – 11 mg (p>0.05). Comparison of changes in the studied parameters during the treatment did not reveal statistically significant differences between the groups. Replacement of drugs in each group after 4 weeks of therapy ensured the preservation of the achieved effect of treatment. No adverse events were recorded during the 8-week course of treatment in both groups.

Conclusion. A pilot comparative study showed that the studied generic drug of ivabradine has a therapeutic effect comparable to the original drug, but studies with a larger number of patients are necessary.

40-46 795

Am. To study in the RECVASA registers the availability of data about the international normalized ratio (INR) indicator and achievement of its target values in outpatient and hospital practice in patients with atrial fibrillation (AF) receiving anticoagulant therapy with warfarin.

Material and methods. Data about the INR control and the frequency of achievement of its target values at the outpatient and hospital stages were analyzed in RECVASA (Ryazan) and RECVASA FP – Yaroslavl outpatient registries, as well as in the hospital registers RECVASA FP (Moscow, Kursk, Tula) in 817 patients (46.9% of men, age 68.5±9.6 years) with AF and the prescribed anticoagulant therapy with warfarin.

Results. INR was determined in 689 (84.3%) of 817 patients. The values of INR were monitored during therapy with warfarin in RECVASA (Ryazan) and RECVASA FP –Yaroslavl outpatient registries in 73.7% and 77.7% of patients, respectively, and in RECVASA FP hospital registers: 95.8% (Moscow); 81.3% (Tula) and 93.5% (Kursk). The target level of INR (2.0-3.0) was achieved in a minority of patients with AF during treatment with warfarin: inRyazan – in 26.3% of cases;Yaroslavl – 38.3%;Kursk – 34.8%;Moscow – 39.5%; Tule – 26.3%. Control of INR in hospital registries during warfarin therapy in patients with AF significantly more often (p<0.05) was performed at the hospital stage, compared with prehospital (in Kursk –2.3 times more often in Moscow – 2.6 times, in Tula – in 1,8 times). The target level of INR in the hospital was achieved significantly more often (p<0.05) than before hospitalization (Moscow andKursk), but no significant differences were found in the RECVASA FP –Tula register (p=0.08). The INR was monitored by 94.9% of the patients; however, the target values of this indicator were achieved only in 33% of cases in the sample study in the RECVASA FP –Moscow registry according to a survey of 39 patients with AF who continued to receive warfarin after 2.6±0.8 years after discharge from the hospital.

Conclusion. INR was monitored in 74-96% of patients with AF treated with warfarin and included in the RECVASA and RECVASA FP registries. Target levels of INR were achieved only in 26-39% of patients. INR was monitored with achievement of its target levels more often at the hospital stage of treatment than before hospitalization and more often than in outpatient registries. In practical public health in patients with AF treated with warfarin, it is fundamentally important to monitor INR and increase the frequency of achieving its target values, at which the risk of cardioembolic stroke and other thromboembolic complications is proven to be reduced.

47-52 698

Background. Carriership of CYP4F2*3 (rs2108622, Val433Met) allelic variant can affect antiplatelet effect of clopidogrel, thus changing efficacy and safety of its standard dose.

Aim. To study the impact of carriership of at least one CYP4F2*3 allele on the risk of resistance to clopidogrel in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI).

Material and methods. The study enrolled 81 patients with ACS and PCI: 64 males and 17 females, mean age 63.9±10.9 years. CYP4F2 allelic variants were detected by the method of real-time polymerase chain reaction. Platelet functional activity was evaluated by a portative aggregometer – the VerifyNow P2Y12 assay.

Results. Pharmacogenetic testing showed that 40 (49.4%) of ACS patients had normal genotype (CC), 38 (46.9%) patients were carriers of one associated with reduced drug metabolism allele (CT genotype), and 3 (3.7%) patients were homozygotes for T (TT genotype). Genotype and allele distribution was in the Hardy-Weinberg equilibrium (c2=2.79; p=0.095). There were no statistically significant differences in CYP4F2*3 allele frequency between patients that are resistant to clopidogrel (PRU>208) and in patients with a normal response to clopidogrel (PRU<208): 36.8% vs 54.8% (р=0.17). Average platelet reactivity units (PRU) and average platelet inhibition (%) in patients with and without T allelic variant of CYP4F2 also were not significantly different: 165.34±51.03 PRU vs 174.8±51.06 PRU (p=0.407), respectively, and 29.51±21.59% vs 27.72±18.35%, respectively (p=0.69).

Conclusion. Carriership of CYP4F2*3 allelic variant does not affect antiplatelet effect of clopidogrel in ACS patients. Further research on larger samples is needed to determine the role of CYP4F2 polymorphisms in personalization of clopidogrel antiplatelet therapy.

53-57 609

Aim. To estimate incidence of periprocedural ischemic brain microlesions after carotid artery stenting (CAS) and to identify most probable predictors. Material and methods. 84 patients with carotid artery stenosis undergoing carotid angioplasty with stenting (CAS) in a specialized medical center, between 2013 and 2016, were examined. All patients had diffusion-weighted magnetic resonance imaging before and after treatment for the detection of new periprocedural ischemic brain microlesions. Statistical analysis was performed using non-parametric methods.

Results. Among the selected patients aged 40 to 83 years (mean age of 60.6±3.9 years) there were 68 men (80.95%) and 16 women (19.05%). 39 (46.4%) of 84 patients had new ischemic brain microlesions after CAS both ipsilateral (37.8%) and non-ipsilateral location. 17.95% of them (n=7) had the transient or persistent neurological symptoms and the rest patients were asymptomatic. Patients with ischemic brain microlesions compared with patients without them were older and had lower hemoglobin level before CAS, history of previous strokes and as well as perioperative arterial hypotension persisting up to 24 hours (p<0.05). Statistically significant differences in atherosclerotic plaques characteristics and CAS technical features were not detected.

Conclusion. Ischemic brain microlesions after CAS, mostly asymptomatic, were detected in about half of patients. Microlesion appearance may be associated with older age, preprocedural lower hemoglobin level, previous strokes and periprocedural hemodynamic instability.

58-64 666

Aim. To evaluate adherence to treatment, mutations of the hemostatic system and food preferences as predictors of choice of optimal anticoagulant therapy in patients with atrial fibrillation (AF).

Material and methods. 142 patients with AF were quantitatively evaluated in terms of their adherence to treatment, polymorphism of genes CYP2C9 and VKORC1 and the structure of food preferences.

Results. Persons with insufficient adherence to treatment prevailed among AF patients, at that the leading negative factor was the low adherence to medical support, which directly related with the frequency of complications and ineffectiveness of anticoagulant therapy. The very high prevalence of gene mutations CYP2C9 and VKORC1 (more than 2.3 per 1 respondent) was detected in the study sample, which makes screening pharmacogenetic testing ineffective and is an independent risk factor for the Omsk region. Consumption by the population of food products that can affect anticoagulant therapy with warfarin does not have special regional characteristics and does not differ significantly among respondents both without AF and with AF (99.2±41.9 vs 100.8±38.6 points; р=0.82) as well as among patients with AF both taking and not taking warfarin (85.4±47.0 vs 107.3±42.1 points, p=0.9).

Conclusion. Individualized choice of anticoagulant in patients with AF should be based on a structured quantitative assessment of adherence to treatment. In low adherence to treatment and choice of warfarin as an anticoagulant, its safety should be confirmed by the assessment of pharmacogenetic status and/or dietary preferences of the patient.


65-69 1181

In connection with the increase in the life expectancy of modern people, in recent years questions of comorbid conditions have become of great interest among clinicians. Comorbidity, which increases with the age of patients, may reduce their adherence to treatment, including because of the use of multicomponent regimens of therapy, which in turn leads to a decrease in the effectiveness of the treatment. In this regard, there is a need for individual adjustment of therapeutic regimens with minimal drug interactions. In the article, a clinical case is presented as a therapeutic and diagnostic algorithm for a comorbid patient with combination of the digestive and cardiovascular systems disorders. The choice of therapeutic-diagnostic algorithm was based on modern Russian and foreign recommendations. The emphasis is on the stratification of both gastroenterological and cardiologic risk factors, and the strategy for choosing proton pump inhibitors, depending on clinical dynamics. The rationale for the replacement of proton pump inhibitors is given, taking into account the probability of inter-drug interactions in a patient with high cardiovascular risk taking acetylsalicylic acid and having a high risk of gastrointestinal tract bleeding. The data of several large meta-analyzes reflecting approaches to reduce the risk of gastropathy associated with non-steroidal anti-inflammatory drugs due to the use of disaggregants as well as eradication therapy in these patients are presented.


70-76 1005

Aim. To analyze the associations of health care system resources utilization and temporary disability (TD) with the main risk factors (RF) for cardiovascular diseases (CVD) in working age population based on ESSE-RF study data.

Material and methods. The analysis was based on ESSE-RF study data (13 regions of the Russian Federation). Standard epidemiological survey methods and evaluation criteria were used. The analysis included results of a survey of the ESSE-RF study participants about the utilization of health services and TD during last 12 months. Average number of outpatient visits, hospitalizations (including duration of in-hospital treatment and number of cases), ambulance calls and TD (a number of days and cases) per one study participant and associations with RF for CVD were estimated. We conducted a comparative analysis of the utilization of health services and TD in association with cardiovascular RF, also logistic regression analysis was performed to predicting the likelihood of outpatient visits, hospitalizations, ambulance calls and TD.

Results. A total of 21,923 individuals in the 25-64 age group were included: men – 8,373 (38%) and women – 13,550 (62%). Number of men who was hospitalized significantly increased in group with tobacco consumption (1,41; p<0,05) and obesity (1,32; p<0,05), also number of participants who call to ambulance increased among smoking men (1,41; p<0,05) and with hyperglycemia (1,38; p<0,05), at the same time number of persons with cases of TD significantly increased just only among smokers (1,29; p<0,05). At the same time, number of women who used health services (exclude in-hospital treatment) and who had a case of TD was significantly increased just only among smokers. The frequency of the utilization of health services and TD cases, the average number of days of hospitalizations and days of TD cases for 1 person depending on the presence/absence of RF had small difference in both men and women. Female obesity is the most resource-intensive RF, as well as male smoking, and was associated with an increase in the likelihood of using all types of medical care and TD cases. Smoking and hyperglycemia significantly increased the likelihood of utilization the most of health services in women, whereas in men hyperglycemia increased only the probability of ambulance calls (1,38; p<0,05), and obesity – only hospitalizations (1,32; p<0,05). Hypertension significantly affected only to ambulance calls in both men and women. Hypercholesterolemia was associated with decreased likelihood of the utilization health services in men.

Conclusion. So, there is a significant association of the health care utilization with the RF depending on the type of medical care, sex and RF.

77-87 672

Aim. To estimate the prevalence of familial hypercholesterolemia (FH) in a sample of Moscow city and Moscow region patients with hypercholesterolemia (HCh) based on lipid spectrum and instrumental methods.

Material and methods. The study included two samples of patients (age >18 years), with total cholesterol (TCh) level ≥7.5 mmol/l and/or low-density lipoprotein (LDL) cholesterol level ≥4.9 mmol/l. First sample (n=60) was included to determine secondary hyperlipidemia frequency in newly diagnosed HCh, with measurement of thyroid hormone, glucose and glycated hemoglobin (HbA1c) levels. Patients of the second sample (n=432) from Russian registry of FH (RuFH) were studied by drug therapy assessment, lipid profile measurements, calculation of FH probability according to Dutch and British criteria, carotids duplex scanning (CDS), cardiac perfusion single-photon emission computed tomography (SPECT/CT) using rest/stress protocol.

Results. The incidence of secondary dyslipidemia due to diabetes or hypothyroidism in patients with severe HCh was 18.3%. Monotherapy with atorvastatin (34.2%) or rosuvastatin (31.8%), combined therapy with statins and other lipid-lowering drugs (24.4%) prevails in the structure of lipidlowering therapy in patients with severe HCh. The frequency of "definite" FH according to Dutch criteria in HCh patients was 15.3%, "probable" – 18.1%. Patients with definite FH diagnosis showed higher level of TCh (p<0.001), LDL cholesterol (p<0.001), proprotein convertase subtilisin/kexin type 9 (p<0.001), lower high-density lipoprotein (HDL; p=0.02), and triglycerides (p<0.001). At that HDL cholesterol levels differed only in patients treated with lipid-lowering drugs. Patients with lipid-lowering therapy had significantly higher values of total stenosis percent, the number of plaques, intima-media complex thickness (p<0.001). Patients with lipid-lowering therapy with a definite and probable FH diagnosis had significantly worse values of CDS parameters. CDS parameters correlated with age in both therapeutic groups, and with maximal TCh levels in history in lipid-lowering therapy group (p<0.01). Patients with HCh and established ischemic heart disease showed higher frequency of positive exercise test result, higher values of left ventricle myocardial perfusion heterogeneity and defect severity parameters according to SPECT.

Conclusion. Patients with severe HCh and suspected FH in Moscow city and region demonstrate satisfactory awareness, but low adherence to therapy, which is also extremely rarely sufficient to achieve target LDL levels and reduce coronary risks. This leads to early manifestations of atherosclerosis, including characteristic progressive impairments of myocardial perfusion. Despite the ongoing work on primary prevention, it is advisable to recommend sending such patients to specialized clinics for more qualified consultations and selection of optimal lipid-lowering therapy with mandatory further monitoring of its effectiveness.


88-93 687

Aim. To study the quality of prehospital therapy in patients with a history of acute coronary syndrome/acute myocardial infarction (ACS/AMI), and included in 2 registers: LIS-3 and PROFILE-IM.

Material and methods. Data on therapy before the reference ACS in the hospital register LIS-3 (Lyubertsy town, 01.11.2013-31.07.2015) and in the AMI outpatient registry PROFILE-IM (Moscow city polyclinic N9) were compared. Anonymized data from the case histories (320 patients from the LIS-3 registry) and outpatient charts (160 patients from the PROFILE-IM register) were analyzed.

Results. Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers before AMI in patients from PROFILE-MI were prescribed significantly more often than in the LIS-3 registry (49.4% vs 39.4%, respectively, p<0.05), as well as calcium channel blockers – 6.7% vs 5.3%, respectively (p<0.05). The frequency of prescription of statins, antiplatelet agents and anticoagulants before reference AMI in patients of both registers did not differ significantly. Assessment of adherence to treatment was performed in the PROFILE-IM registry. 56 (35.0%) patients did not take medication. Among cases with pharmacotherapy only 41 (39.4%) patients had regular taking, and 24 (23.1%) took medication in worsening health, 39 (37.5%) had only short medication courses. Similar data were revealed in patients already having ischemic heart disease.

Conclusion. Primary and secondary drug prevention of AMI in both registries did not meet modern clinical guidelines. This was especially true for patients with already established ischemic heart disease and to the greatest extent, according to both registries, refers to drugs from the statin group.


94-100 940
Histological analysis of endomyocardial tissue is still the gold standard for the diagnosis of cardiac amyloidosis but has its limitations. Accordingly, there is a need for noninvasive techniques to cardiac amyloidosis diagnostics. Echocardiography and magnetic resonance imaging can show characteristics which may not be very specific for cardiac amyloid. Recently, new opportunities of nuclear imaging in risk stratification and assessment of prognosis for patients with cardiac amyloidosis have appeared. During the last two decades different classes of radiopharmaceuticals have been developed based on compounds tropic to the components of amyloid infiltrates. In this paper we describe the current possibilities and perspectives of nuclear medicine techniques in patients with cardiac amyloidosis, including osteotropic and neurotropic scintigraphy, single-photon and positron emission tomography


101-110 2888

An increase in the prevalence of chronic noncommunicable diseases is a significant problem for both patients and the health system. According to the World Health Organization "Promoting effective responsible self-care ... is essential to reduce the financial burden on health systems". The term "responsible self-care" means "self-help" and "self-care". The concept of responsible self-care is to create conditions and prerequisites for forming a responsible attitude to own health, children's and family's health by maintaining a healthy lifestyle, wider and more competent use of over-the-counter medication for the prevention or self-care of the trifling ailment and chronic non-communicable diseases, continuing the therapy prescribed by the doctor. Changes in the legislative framework, coordinated activity of medical workers of various levels and specialties, as well as improvement of medical literacy of the population are necessary for the implementation of the practice of responsible self-care in Russia. Promotion of healthy lifestyles and the personal responsibility of people for their health in the media and Internet resources, self-monitoring of the status and basic health indicators, increasing adherence of patients to prescribed medicines for the treatment of chronic diseases based on gained medical know-ledge, skills and habits are the most applicable measures for Russia to date.

111-121 1739

The immediate and remote benefits of smoking cessation are considered. Within one year after quitting smoking the ischemic heart disease (IHD) risk will be 2 folds lower than the risk in smoking patient. Within 15 years the IHD risk declines to non-smoking population level. After 5-15 years after quitting smoking the risk of stroke also declines to non-smoker risk. Smoking cessation prior to cardio surgical intervention leads to reduction of complications incidence by 41%. Smoking cessation significantly reduces the risk of developing stable and unstable angina, acute myocardial infarction, cardiovascular death, transient ischemic attack, ischemic stroke, subarachnoid hemorrhage, intracerebral hemorrhage, peripheral arterial diseases, abdominal aortic aneurysm at any age, in both sexes in comparison to patients who continue to smoke. Smoking cessation is the most cost-effective strategy of cardiovascular disease prevention. Today, the most effective smoking cessation strategy is the identification of smokers and continuous advice on smoking cessation, and offer of the appropriate medication, primarily varenicline. The article contains data from a number of studies showing that varenicline is an effective and safe drug for tobacco dependence treatment, in particular, in patients with acute and chronic cardiovascular disease. 

122-130 784

The article presents a critical analysis of the results of a large clinical trial SPRINT. The focus is on the issues related to the blood pressure (BP) measurement in this trial.

The aim of SPRINT trial was to prove the benefit of reducing systolic BP (SBP) below 120 mm Hg in high-risk hypertensive patients. A total, 9,631 highrisk participants without history of diabetes mellitus or stroke were randomly allocated to a standard treatment group (target SBP<140 mm Hg) or an intensive treatment group (target SBP<120 mm Hg). Significantly lower rates of all-cause mortality (by 27%) and cardiovascular events (by 25%) were observed in the intensive treatment group, compared to the standard treatment one. Therefore, the intervention was stopped early, after a mean follow-up of 3.3 years (instead of 5 years, as specified in the study protocol).

However, the SPRINT study used an unusual method of clinical BP measurement, the so-called automatic office BP (AOBP) measurement. An important feature of AOBP is that it provides significantly lower BP values, compared to the conventional clinic BP measurement. This article reviews the publications which aimed to provide an independent evaluation of the SPRINT results. It appears that if traditional clinic BP measurement was used in SPRINT, the mean SBP level in the control group could be approximately 150 mm Hg, which is substantially higher than the generally accepted threshold of 140 mm Hg. This could explain a higher prevalence of cardiovascular events in the control group. The estimated SBP level in the intensive treatment group (132-136 mm Hg) is not very different from the standard threshold.

Therefore, the SBP target in the treatment of hypertension remains unchanged at <140 mm Hg. AOBP is a specific subtype of the clinic BP measurement. The currently proposed AOBP threshold (135/85 mm Hg) warrants further investigation.


131-136 785

Anticoagulant therapy is widely used in all forms of acute coronary syndrome (ACS) to inhibit the formation of thrombin and/or to inhibit its activity to reduce the risk of thrombotic events (both in primary percutaneous coronary intervention and in the absence of revascularization). Of the entire range of anticoagulants offered by the domestic and foreign pharmaceutical industry, a limited number of drugs of this group are used in the treatment of ACS, in particular, unfractionated heparin and low molecular weight heparin – enoxaparin.

Enoxaparin has a safety profile and clinical efficacy at least comparable to that of unfractionated heparin, and at the same time has a number of obvious advantages, such as a simpler protocol of administration and dosing, does not require routine monitoring of the parameters of the blood coagulation system. In patients with ACS with ST-segment elevation the routine administration of enoxaparin should be considered as an alternative to the standard regimen of unfractionated heparin therapy. In patients with ACS without ST-segment elevation enoxaparin should be used when fondaparinux is unavailable.





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