Search

Aim. To compare reverse remodeling process after coronary bypass surgery (CBS) in coronary heart disease (CHD) patients with and without Q-wave myocardial infarction (Q-IM) in anamnesis. Material and methods. The study included 133 CHD patients after CBS; mean age - 56,03±8,90 years. According to Q-IM presence, all participants were divided into two groups: Group I (n = 71) - patients without MI in anamnesis (61,97%; n = 44) or with non-Q-MI (38,03%; n = 27); Group II (n = 62) - patients with Q-MI in anamnesis. All participants underwent echocardiography for three times: before surgery; in early (4,2±1,3 days later) or longterm post-surgery period (2,53±1,31 years later). Results. Positive dynamics in cardiac structure and function among CHD patients after CBS was registered regardless of MI presence in anamnesis. Nevertheless, dynamics intensity differed in patients with non-Q-MI and Q-MI in anamnesis. Early significant increase in ejection fraction (EF) and decrease in abnormal local contractility index were observed in individuals with large infarction zones, due to multiple zones with restored local contractility. In long-term follow-up, volume parameters returned to baseline, but in patients with Q-MI, significant EF improvement persisted. Conclusion. Positive influence of CBS on myocardial contractility in patients with Q-MI in anamnesis persisted in long-term post-surgery period.

Aim. To investigate the prognostic role of selected single nucleotide polymorphisms in hemostasis-regulating genes and to clarify their interaction with conventional risk factors, RF (smoking, arterial hypertension (AH), hypercholesterolemia (HCH), obesity (O)) at the early stages of coronary heart disease (CHD) development, with or without subsequent myocardial infarction (MI). Material and methods. The study included 977 men aged 20–55 years: 375 CHD patients (189 and 186 with or without previous MI, respectively) and 602 individuals without cardiovascular disease (CVD). Exclusion criteria were diabetes mellitus and impaired glucose tolerance. The authors analysed the polymorphisms of thrombocyte receptor genes GPIa (C807T) and GPIIIa (PLA1/PLA2); coagulation and fibrinolytic protein genes for factor VII (R353Q) and factor XIII (V34L); and the plasminogen activator inhibitor-1 (PAI-1) 4G/5G polymorphism. The association of these polymorphisms with conventional RF (smoking, AH, HCH, and O) was also investigated. To identify genetic variations, a restriction fragment length polymorphism assay, allele-specific assay, and fluorescence primer-probe assay were used. Results. Increased CHD risk was associated with the TT genotype of GPIa (p=0,0001; OR=10,2). The LL genotype of FXIII (p=0,03; OR=0,48) and QQ genotype of FVII (p=0,01; OR=0,12) were linked to reduced CHD risk. The combination of FXIII L allele and FVII Q allele was associated with a lower MI risk in CHD patients (p=0,03; OR=0,33). In participants with HCH, the PLA2/PLA2 genotype of GPIIIa was linked to increased MI risk for CHD patients (p=0,01; OR=6,0). Conclusion. The algorithm for predicting the genetic CHD risk may incorporate the assessment of the genetic polymorphism of GPIa (C807T), GPIIIa (PLA1/PLA2), factor XIII (V34L), and factor VII (R353Q). The study results did not confirm the negative effect of the PAI-1 gene 4G/5G polymorphism on CHD risk.

Aim. To differentiate angiotensin II receptor blockers (ARBs) by vascular effects and outcomes in trials on cardioprotective endpoints. Data sources. MEDLINE searches were conducted from January 2003 to March 2009 using the following search terms: renin-angiotensin-aldosterone system (RAAS) blockade or inhibition; angiotensin II receptor blocker (ARBs); cardioprotection; vascular protection; end-organ protection; candesartan; eprosartan, irbesartan; losartan; olmesartan; telmisartan; and valsartan. Ongoing and recruiting clinical trials were identified via Clinicaltrials.gov (July 2008). Study selection and data abstraction. Pertinent basic science research and clinical trials with cardiovascular endpoints and information from reviews, American Heart Association 2009 statistics, and The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines were included in this review.Data Synthesis. ARBs differ in their vascular protective pleiotropic effects and pharmacokinetic properties, which may contribute to their pharmacological protection to reduce cardiovascular morbidity and mortality, independently of their blood pressure (BP)-lowering effects. Conclusion. Emerging data show that ARBs are effective in hypertension, left ventricular hypertrophy, postmyocardial infarction, and heart failure. To what extent their pleiotropic effects, independent of BP lowering, contribute to these outcomes will be the focus of research in the coming years. Well-designed, comparativeeffectiveness studies are needed to clinically differentiate this class of agents. The future will be marked by multifunctional ARBs that will pharmacologically do more than antagonize the angiotensin type I (AT1) receptor.

This review discusses the mechanisms of heart rate and blood pressure regulation in healthy people and patients with arterial hypertension. The role of time and spectral parameters of heart rate variability (HRV) in the assessment of autonomic status of these patients, especially during orthostatic test, is described. The paper also contains the results of the studies investigating antihypertensive medications’ effects on HRV structure.

High effectiveness and safety of beta-adrenoblockers (BB) in patients with coronary heart disease (CHD) have been proven by manifold clinical trials. BB are effective and safe, provided dose regimen is correct and contraindications are taken into account. BB significantly reduce total mortality and sudden cardiac death risk in CHD patients.

Aim. To assess effectiveness and tolerability of morning / evening-administered rilmenidine in patients with work-place arterial hypertension (WpAH), during combination therapy. Material and methods. This randomized, short-term (8 weeks), pilot study included 20 males (mean age 48,5 years) with Stage I (n = 5) or Stage II (n = 15) AH, risk II (n = 4) or III (n = 16). Rilmenidine was administered in the morning (n = 10) or in the evening (n = 10). If needed, beta-adrenoblockers, ACE inhibitors, diuretics, nitrates, and digoxin were administered. The end-points included: blood pressure (BP) normalization - for mean daily ВР, according to 24-hour BP monitoring (BPM), and office BP (oBP); therapy response; circadian BP profile dynamics; temporary index (TI); circadian rhythm; quality of life (QoL); laboratory and instrumental parameters dynamics. Results. After 8 weeks of rilmenidine-based therapy, systolic oBP (SoBP) was normalized in 95% of the participants, diastolic oBP (DoBP) - in 100%. Mean daily DBP normalization, according to 24-hour BPM, was registered in all patients, and nighttime SBP response to treatment - in 90%. In the morning administration group, DBP was reduced by 22,1%, in the evening one - by 22,7%. For all time periods, pressure load on target organs substantially lowered. In the morning administration group, TI for daily SBP decreased by 53%, in the evening administration group - by 61,5%, TI for DBP - by 44,4% and 66,6%, respectively. Initially disturbed circadian rhythm normalized in 40% of the patients. The combination of rilmenidine with beta-blockers or ACE inhibitors was the most effective for BP reduction. Conclusion. Antihypertensive effect of rilmenidine-based therapy was combined with reduction in pressure load on target organs, as well as circadian BP rhythm improvement, and perfect tolerability

Aim. To compare the effects of combination therapy with Noliprel A/forte (perindopril/indapamide) and lowintensity laser therapy (LILT) on central hemodynamics in elderly patients with arterial hypertension (AH). Material and methods. In total, 160 AH patients, aged 60-96 years, were examined. All participants were randomised into 4 groups: Group I (n=25) receiving Noliprel A/forte; Group II (n=54) receiving red-spectrum LILT on skin Zakharyin-Ged zones, plus pharmaceutical therapy (excluding noliprel); Group III (n=27) receiving Noliprel A/forte and LILT; and Group IV (n=54), the comparison group, receiving standard antihypertensive therapy only (excluding Noliprel A/forte and/or LILT). At baseline and in the end of the study, Doppler ultrasound parameters were assessed. Results. At baseline, AH patients demonstrated relatively normal systolic myocardial function combined with diastolic left and right ventricular (LV, RV) dysfunction and increased ventricular transverse sizes. By the end of the study, Group I demonstrated reverse remodelling of all cardiac chambers. The combination of Noliprel A/forte and LILT had additive beneficial effects on morphological and functional components of intracardiac hemodynamics, with LV and RF systolic function improvement and even more pronounced regression of LV and RF diastolic dysfunction. The beneficial impact of noliprel was maximal in patients aged over 80 years. Conclusion. The combination of noliprel and LILT demonstrated additive beneficial effects and increased treatment effectiveness independently of AH variant, intracardiac hemodynamic specifics, and age.

According to the modern views, coronary heart disease (CHD) is a heterogeneous disease with pathophysiological and pathomorphological features. In clinical practice, CHD often is combined with other cardiac and extracardiac pathology, which results in certain clinical CHD types. The review describes the best-known of these types, as well as suggests the potential new types, which might affect early diagnostics and effective treatment of CHD.

Such periinterventional complications of percutaneous coronary intervention (PCI) as myocardial infarction (MI), “no-reflow/slow-flow” phenomenon, and stroke, affect long-term survival. Therefore, their risk should be effectively stratified and reduced. The existing approaches for predicting the risk of periinterventional complications are typically focussed on assessing the fatal outcome probability and do not consider modifiable risk factors, which restricts their use to evaluation of PCI benefits and risk only. Periinterventional statin therapy reduces the risk of periinterventional MI both in patients with stable angina and individuals with acute coronary syndrome. This beneficial action could be related to anti-inflammatory, antioxidant, antithrombotic, NO- and immunomodulating effects of statins. The evidence on cardioprotective effects of periinterventional beta-blocker therapy is contradictory for PCI patients. Existing data on the link between beta-blocker treatment and increased risk of “slow flow” phenomenon, coronary artery spasm, heart failure, and arterial hypotension point to the need for optimisation of the pulse-reducing component of pharmaceutical PCI support. One of the promising methods for solving this problem could be administration of ivabradine – a medication with confirmed anti-ischemic and antianginal action, but no effects on myocardial contractility or blood pressure level.

Aim. To study physical training (PT) antihypertensive effects and influence on left ventricular (ГУ) structure and function, cerebral blood flow, and endothelial vasokinetic function in patients with arterial hypertension (AH). Material and methods. In total, 74 AH patients were examined at baseline, while receiving two-week indifferent therapy, and then after one-month PT course. PT effectiveness was assessed by 24-hour blood pressure monitoring (BPM). Target organ influence was assessed by echocardiography, transcranial duplex sonography of cerebral vessels, with functional metabolic and myogenic tests, as well as with ultrasound endothelial function assessment. Results. One-month PT was effective as a method of antihypertensive therapy in 47% of the patients. For systolic and diastolic BP, mean daily figures and BP load indices were reduced. PT did not affect TV structure. In patients with antihypertensive PT effect, TV early diastolic filling velocity increased, as well as peripheral resistance indices for intracranial cerebral arteries. Positive dynamics of cerebral blood flow auto-regulation was observed. Fndothelium-dependent vasodilatation improvement was observed in all AH patients, regardless of PT effect, but more significantly in BP reducers. Conclusion. PT effectiveness for systemic BP reduction in Stage I-II AH patients reached 47%. Beneficial PT effects on target organs were more manifested in individuals with greater BP reduction.

Aim. To assess the role of genetic factors in coronary atherosclerosis progression and myocardial electric instability development among patients with coronary heart disease (CHD) undergoing endovascular interventions. Material and methods. The main group (MG) included 97 CHD patients (mean age 53,6±7,8 years), who underwent endovascular revascularization. The assessed parameters included genetic polymorphisms of haptoglobin (Hp), C´3 complement component (C´3), vitamin D-binding protein (Gc), and transferrin (Tf), as well as immune inflammation markers (interleukin-6, tumor necrosis factor-α, and C-reactive protein, CRP) and electrocardiographic QT interval dispersion. The control group (CG) included 100 healthy donors (mean age 47,0±8,6 years).Results. In MG patients, compared to controls, there was a significant increase in QT interval dispersion. The extent of QT interval dispersion reduction after endovascular coronary stenting was maximal in patients with one or two lesions. At early post-intervention stages, immune inflammation processes intensified. The severity of coronary atherosclerosis affected the correlation between CRP levels and QT interval dispersion. QT dispersion parameters were associated with Hp 2–2, С´3 SS, Gc 1–1, and Tf CC. In С´3-SS-positive patients, there was a positive correlation between CRP levels and QT interval dispersion (QTd). Conclusion. The results obtained confirm the important role of genetic factors in the immune inflammation activation among CHD patients. After endovascular intervention, immune inflammation is associated with atherosclerosis progression and myocardial electrical instability

Aim. To investigate clinical role of serum apolipoprotein B (apo B) levels in coronary heart disease (CHD). Material and methods. The study included 122 patients (mean age 49,7±7,1 years) with possible CHD diagnosis, who underwent clinical and instrumental examination. The diagnosis was confirmed by anamnesis data, stress tests and coronary angiography results. Apo B concentration was measured by immune-enzyme method. Results. In women, sensitivity of elevated apo B levels was lower than that of hypercholesterolemia (HCH); nevertheless, specificity of both parameters was similar. In men, HCH was more sensitive and specific than increased apo B levels. Conclusion. Substantial differences in sensitivity and specificity of increased apo B levels were observed in women and men with possible CHD, as well as in various groups of men.

Left ventricular hypertrophy (LVH) is an important, independent risk factor for not only total and cardiovascular mortality, but also for sudden cardiac death. Following blood pressure increase in hypertrophied LV, due to myocardial diastolic dysfunction, left atrium dilates very fast. That results in supraventricular extrasystolia, atrial fibrillation and flutter in 25-50% of the patients with arterial hypertension (AH). The link between LVH and ventricular arrhythmia incidence and severity depends on LVH stage, and might be absent at mild to moderate, close to physiological, stages. Association between LVH and spontaneously induced ventricular arrhythmia has been demonstrated in adequately controlled experimental studies. In AH and LVH patients, arrhythmogenic risk factors include the following: late ventricular potentials, decreased heart rate variability, prolonged QRS duration, increased T interval dispersion and T wave alteration. Assessing arrhythmia risk in asymptomatic patients is a difficult task, that could be solved with an algorrhytm proposed.

Over the last few decades, vast evidence has emerged, confirming polygenic hereditary nature of arterial hypertension (AH). Reduced renal salt excretion, genetic or acquired due to diseases, ageing, obesity, or other factors, is a key mechanism in AH pathogenesis. AH development should be regarded as a compensatory reaction, aimed at increasing renal salt excretion, normalising circulating blood volume, and maintaining homeostasis.

Fpidemiology studies have confirmed a hypothesis on pre-natal risk determination for metabolic syndrome (MS), arterial hypertension (AH), and coronary heart disease (CHD). Gestational diabetes (GD) and obesity are typical metabolic disturbances in pregnancy. Insulin resistance (IR) development at early gestation stages results in fat tissue proliferation and increased feto-placental nutritious value by late pregnancy stages, when fetus weight increases by 70%. Increased IR in mother provides reproductive benefit in case of under-nutrition and over-working, at the same time being able to result in GD, when combined with calorie-rich diet and sedentary lifestyle. Increased IR and pre-conception obesity increase macrosomia and fetus overweight risk. Overweight children of GD mothers have increased risk of juvenile obesity and type 2 diabetes mellitus (DM-2). Decreased fetal height and body size in pregnancy and early post-natal period could also result in DM and MS later in life. In spite of low cardiovascular morbidity in young women, gestational hyperglycemia combined with pre-pregnancy obesity, as well as gestational hypertensive syndrome, significantly increase cardiovascular risk. Women with pregnancy-diagnosed metabolic disturbances and AH, as well as their children, need to be actively followed-up and treated, if necessary.

The article is focused on modern approaches to heart rate reduction, as a new method for stable angina (SA) management. The algorhithm of SA pharmaceutical treatment, by the European Society of Cardiology (2006), is analyzed.

Aim. To study the role of fixed, low-dose perindopril/indapamide combination in the treatment of patients with arterial hypertension (AH) and inadequate blood pressure (BP) control. Material and methods: In total, 1726 AH patients with inadequate BP control were divided into three subgroups: I – patients with first-diagnosed AH (n=598, 37%), II – patients whose previously taken antihypertensive agent was changed to Noliprel® (n=582, 35%), and III – patients receiving previous antihypertensive therapy and Noliprel® (n=458, 28%). Subgroups were formed by the doctors. All participants were administered Noliprel®; the dose was doubled if one-month treatment was ineffective (Noliprel® forte). Therapy effectiveness was assessed by office BP measurement at baseline, after 1 and 4 months of the treatment. At 14 clinical centers (n=280), more detailed investigation of treatment safety and effectiveness was performed, including 24-hour BP monitoring (BPM) and blood biochemical analysis at visits 1 and 3. Results. After 4 months of treatment, in the whole group and in subgroups, systolic and diastolic BP levels were significantly reduced, according to office measurement and 24-hour BPM. Noliprel®/Noliprel® forte therapy was safe and well tolerated by the patients. Conclusion. Fixed combination of antihypertensives (Noliprel®/Noliprel® forte) effectively and safely reduced BP in patients with uncontrolled AH. Noliprel® therapy was associated with target BP level achievement not only in first-diagnosed AH, but also in case of ineffective previous antihypertensive treatment.

This literature review is focused on psycho-emotional status in patients with various clinical forms of coronary heart disease (CHD), as well as the specifics of autonomic regulation and clinical course, including CHD prognosis. The authors describe selected methods for objective dynamic assessment of these characteristics and their interrelations.

Vascular wall infiltration with lipoproteins, in particular with low-density lipoprotein (LDL) cholesterol (LDLCH), plays an important role in atherosclerosis pathogenesis. Elevated LDL-CH levels are associated with increased risk of coronary heart disease (CHD). Based on the evidence from experimental and clinical studies, there is a direct link between LDL-CH reduction and decreased incidence of cardiovascular events. Statins are medications of choice for LDL-CH reduction; however, statin monotherapy does not always result in target LDLCH level achievement, due to pharmaco-genetic factors and adverse effects of the therapeutically effective statin doses. In these clinical situations, a combination of low-dose statins with other lipid-lowering agents is effective. Recently, high effectiveness of statin combination with ezetimibe (inhibitor of intestine CH absorption) has been demonstrated. It is explained by targeting both mechanisms which determine blood CH levels (intestine absorption and hepatic synthesis), with a substantial reduction in LDL-CH levels as a result.

Inflammation and thrombosis play an important role in pathogenesis of various cardiovascular diseases (CVD). The studies on atherosclerosis and acute coronary syndrome (ACS) pathogenesis have demonstrated the interaction of these two systems. One of the mechanisms linking inflammation and thrombosis is activation of signal system CD40/CD40L. CD40 and CD40 ligand (CD40L) are transmembrane glycoproteins, related to tumor necrosis factor (TNF) receptor family and TNF family, respectively. CD40 and CD40F are expressed by various cells, including atherosclerotic plaque cells: В-lymphocytes, macrophages/monocytes, endotheliocytes and smooth myocytes. Recently, it has been discovered that platelets can be a source of soluble CD40L form (sCD40FL. In recent clinical trials, diagnostic and prognostic role of sCD40L had been studied in patients with coronary heart disease (CHD). In individuals with myocardial infarction and unstable angina, sCD40L levels are significantly higher than in healthy persons or patients with stable angina. Prognostic sCD40L value was investigated in healthy women and ACS patients; high sCD40L levels independently predicted increased CVD risk. Raised plasma levels of sCD40L are associated with restenosis after balloon coronary angioplasty. Moreover, sCD40L concentrations are increased in Type 1 and 2 diabetes mellitus, hypercholesterolemia, acute cerebral ischemia, smoking, primary and secondary pulmonary hypertension. Therefore, sCD40L could be regarded as inflammation and thrombosis marker. Its increase is a CVD risk factor, associated with poor prognosis in CHD patients.

The Round Table Discussion «New concept of cardiovascular disease prevention: combined treatment role» was held in Moscow, July 15th 2006, with the support of «Dr Reddy’s» pharmaceutical company (India).

Aim. To analyze diagnostic defects and to identify objective and subjective factors causing inadequate emergency cardiac medical care (ECMC). Material and methods. Two thousand medical histories of patients hospitalized with myocardial infarction (MI) and acute coronary syndrome, were analyzed. Results. Adverse outcomes were registered in 312 cases (15,6 %), including diagnostic defects in 83,3 %. The causes included inadequate doctor qualification (52,6 %), diagnostics and treatment inaccuracy (48,4 %), haste (44,6 %), or combination of inadequate qualification, inaccuracy, and specialist incompetence (34,6 %). Low doctor qualification resulted in inattentiveness (21,5 %) and uncertainty (19,6 %). Over-self-assurance (11,5 %), associated with underestimation of complaints, anamnesis, or clinical data, caused late MI and unstable angina diagnostics. Conclusion. Continuous analysis of ECMC defects, their causes and sources could improve ECMC quality and decrease the risk of legal actions initiated by patients and their relatives.

Various clinical forms and complications of atherosclerosis remain the leading causes of morbidity and mortality in both developed and developing countries. HMG-CoA reductase inhibitors (statins) are the key components of pharmaceutical treatment in patients with dyslipidemia (DLP) and atherosclerosis. Statins have been thoroughly studied not only in randomised clinical trials with “hard” end-points, but also in the so called regression studies. The latter tested the hypothesis of qualitative and quantitative changes in coronary arteries (CA) due to aggressive reduction (-40-50% from baseline) of low-density lipoprotein (LDL) cholesterol levels. The results of the first regression studies justified the increase of statin doses in clinical practice, as well as led to large randomised clinical trials of statin therapy. In current regression studies, vascular atherosclerosis is monitored using such methods as intima-media thickness assessment, magnetic resonance imaging, and intravascular ultrasound. Reduced progression of carotid atherosclerosis (METEOR Study, rosuvastatin 40 mg/d; ENHANCE Study, ezetimibe 10 mg/d plus simvastatin 20 mg/d) and CA atherosclerosis (REVERSAL Study, atorvastatin 80 mg/d), as well as atherosclerosis regression (ASTEROID Study, rosuvastatin 40 mg/d), was demonstrated. Aggressive lipid-lowering effect (-40-50%), observed for high statin doses in modern regression clinical trials, was well-tolerated, with no severe adverse events. The results and principles of regression studies could be widely used in clinical practice, to optimise the treatment of severe DLP and atherosclerosis.

Aim. To assess atorvastatin lipid-lowering effect and tolerability at the initial stage of lipid-lowering treatment. Material and methods. The study included 47 patients (14 women, 33 men; mean age 55,6±11,6 years). Inclusion criteria were: verified coronary heart disease, CHD (stable effort angina, post-infarction cardiosclerosis), total cholesterol (TCH) level >5,0 mmol/l, low-density lipoprotein (LDL) CH level >3,0 mmol/l, triglycerides (TG) level _

Atherosclerosis is one of the most urgent problems in modern cardiology. Atherosclerosis instability and coronary heart disease clinical course are based on plaque ulceration, rupture, and atherothrombosis. Atherothrombosis causes 28% of all deaths worldwide. Therefore, usage of medications targeted on atherosclerosis is very important. One of such agents is clopidogrel - thienopyridine, first used in patients with effort angina, stroke (S), or peripheral artery disease, PAD (1997). Clopidogrel demonstrates polyvalent anti-aggregant effects on platelets. Adding clopidogrel to standard therapy improves outcomes in non-ST elevation acute coronary syndrome patients of low, intermediate, and high risk. Relative risk (RR) of death, myocardial infarction (MI), and S decreases by 20%, irrespective of standard treatment. In patients with recent MI, S, or severe PAD, long-term (three-year) clopidogrel treatment reduces RR of MI, S, or cardiovascular death by 8,7%, comparing to aspirin treatment. Clopidogrel prevents ischemic events more effectively (by 26%) than aspirin

Anemia, more prevalent in women than in men, is an independent predictor of cardiovascular disease (CVD) adverse outcomes. Principal methods for anemia correction in CVD patients are discussed; benefits and disadvantages of various therapeutic strategies are considered.

Percutaneous coronary intervention (PCI) in coronary bifurcation stenosis is still regarded as technically complicated, due to the risk of lateral branch occlusion. Bifurcation stenosis is also characterised by higher intervention costs and restenosis incidence. Over the last 10 years, a range of new stenting techniques for coronary bifurcation stenosis treatment have been developed. These methods improved the rates of short-term PCI success, while drugeluting stents substantially reduced restenosis incidence. However, the limitations of existing methods make the intervention technically challenging and negatively affect long-term PCI results. This paper describes an original PCI method for bifurcation stenosis treatment, called TABAs.

Clinical trials of modern antiarrhythmics often demonstrate their ineffectiveness in life-threatening ventricular arrhythmias and sudden cardiac death (SCD), as well as inadequate pharmacological control in atrial fibrillation (AF). Together with cholesterol-lowering effect, statins demonstrate various pleiotropic effects (anti-inflammatory, anti-proliferative, endothelial function improvement, etc.). Statins can reduce the risk of life-threatening arrhythmias and SCD in patients with acute myocardial infarction, after coronary revascularization and implantation of cardioverter-defibrillator. Statin therapy may decrease recurrent AF risk.

Beta-adrenoblockers, included in any cardiovascular disease treatment standard, became a key part of clinical practice only in late XX century. Nebivolol is a highly selective beta-1 -adrenoiblocker, modulating endothelial NO release and subsequent physiological vasodilatation. Nebivolol has multiple clinical indications, including coronary heart disease, arterial hypertension, and chronic heart failure. Due to its super-selectivity it can also be beneficial in patients with diabetes mellitus, chronic obstructive pulmonary disease, and erectile dysfunction.

Recently, the perception of microalbuminuria (MAU) has progressed from an indicator of renal artery dysfunction to a marker of systemic endothelial dysfunction, predicting cardiovascular risk. MAU is also a significant marker of vascular pathology, including renal, peripheral, cerebral vessels and aorta. Therefore, primary and secondary MAU prevention with angiotensin II inhibition (often as a part of combined therapy) is one of the main goals in nephro-, cardioand vasoprotection.

Lercanidipine is a lipophilic dihydropyridine (DHP) calcium antagonist (CA) with a long receptor half-life. The slow action onset prevents reflex tachycardia, typical for other DHP CAs. Taken once a day, lercanidipine provides an even, sustained antihypertensive action. Its antihypertensive activity is equivalent to many other medications, and lercanidipine is effective as monotherapy or in combination. Its effectiveness has been demonstrated in various age groups, as well as in patients with additional risk factors. Lercanidipine is well tolerated, and adverse effects, typical for DHP CAs, are observed early in the treatment. Lercanidipine therapy is associated with lower incidence of pedal oedema and subsequent treatment withdrawal, compared to amlodipine and nifedipine GITS. In preclinical and preliminary clinical trials, lercanidipine demonstrated anti-atherosclerotic effects and left ventricular hypertrophy reduction. Its effectiveness and tolerability profile make lercanidipine a suitable choice for treating various clinical groups of patients with arterial hypertension.

Aim. To study the levels of biochemical markers of cardiovascular risk (CVR) and the ultrasound-assessed target organ damage (TOD), such as intima-media thickness (IMT), atherosclerotic plaques (AP) in carotid arteries (CA), and left ventricular myocardial mass index (LVMMI), in patients with low and intermediate risk by the SCORE scale (ESH/ ESC 2003, 2007). Material. The study included 600 individuals aged 30-65 years (445 women, 155 men) with low and intermediate CVR by SCORE scale, without manifested atherosclerotic pathology or diabetes mellitus. Methods. CVR was stratified by: SCORE scale and clinical recommendations by ESH/ESC (2003, 2007); duplex CA ultrasound, IMT and CA AP assessment; Doppler echocardiography with LVMMI calculation (Penn-cube method); blood biochemistry with lipid profile, blood glucose, and serum creatinine (Cr) level assessment. Results. Dyslipidaemia was observed in all clinical groups; however, no significant differences between the groups were observed for the participants aged ≤45 years. In participants aged 45-55 and ≥55 years, there was a statistically significant IMT difference between low and intermediate risk groups (р=0,03 and 0,01, respectively). Conclusion. The proportion of people with dyslipidaemia was high in all risk groups, regardless of age. CA AP were registered across all groups, regardless of risk level and age. No statistically significant differences were observed for the groups “intermediate risk, one AP” and “high risk, 1 AP”.

Aim. In the Russian national representative sample, to investigate gender-specific associations between educational level and body mass parameters: body mass index (BMI), waist circumference (WC), abdominal obesity (AO), as well as the links between education and cardio-metabolic risk (CMR) components – arterial hypertension (AH) and diabetes mellitus (DM).Material and methods. The study included 9686 people aged 24-84 years: 3980 men and 5706 women. Response rate was 87,8%.Results. Higher-educated people demonstrated lower levels of BMI and WC, lower prevalence of AO and clinical states associated with increased BM – AH and AH + AO (р

In the Russian Federation (RF), high mortality in young, working-age population substantially affects the present demographic situation. Non-communicable disease, especially cardiovascular disease (CVD), is the leading cause of premature death. RF is characterized by substantial impact of lifestyle factors (alcohol abuse, smoking, unhealthy diet, low physical activity, as well as arterial hypertension and psychosocial stress) on population health, including CVD incidence, progression and mortality. In the complex activity on decreasing CVD burden in Russia, prevention is the priority. Preventive measures should be the very basis of long-term national programs. To secure the effectiveness of such programs, state policy, inter-sectoral collaboration, professional and material resources are necessary.

Aim. To study the effects of work conditions on coronary heart disease (CHD) and its risk factor (RF) prevalence in automobile transport drivers (AD), to assess AD work capacity and to define CHD prevention vectors. Material and methods. Standard epidemiologic methods were used in 1196 urban AD and 1075 rural AD (main group), as well as 864 urban and 687 rural non-drivers – males of the same age (control group). To assess CHD and its RF prevalence according to automobile transport type, three subgroups were formed: lorry AD (n=408), autobus AD (n=421), and taxi AD (n=416). Professional work capacity was assessed by psycho-physiological testing (PPT). Results. CHD and/or its RF prevalence was higher among urban and rural AD than in controls; in general, this prevalence correlated with age and professional service length. Higher rates of CHD and myocardial infarction (MI), as well as smoking, low physical activity, arterial hypertension (AH), dyslipoproteinemia, left ventricular hypertrophy, were observed in AD, comparing to non-drivers (p

Aim. To assess psycho-emotional disorder (PED) impact on cardiovascular system status in climacteric women. Material and methods. This case-control study included 186 climacteric women with manifested PED. All participants gave their informed consent. The control group included 186 women without PED. Menopause syndrome severity was assessed with modified menopausal index. Depression was diagnosed according to ICD-10; its severity was assessed with Beck’s Depression Inventory and Hospital Anxiety and Depression Scale. Results. In all 186 women from the main group, depression was diagnosed, climacteric syndrome (CS) was more severe, and apolipoprotein B level was higher than in controls. Cardiovascular disease (CVD) and vascular event risk was significantly higher in depressed patients. Conclusion. In climacteric women, depression increased CVD risk and aggravated CS clinical course.

Aim. To study the prevalence of choleretic system pathology in patients with coronary heart disease (CHD) and recent acute coronary events; to assess the effects of the long-term, moderate-intensity physical training (PT) programme on the gallbladder (GB) function, lipid metabolism, and exercise capacity (EC). Material and methods. First, the prevalence of gastrointestinal symptoms was assessed in CHD patients with recent acute coronary events. Second, 85 patients with concomitant GB dysfunction were randomised into the main group (MG; n=43) receiving moderate-intensity PT, or the comparison group (CG; n=42). The intervention effectiveness was assessed by the clinical, functional, and biochemical parameters at baseline and 12 months later. All patients received standard pharmaceutical treatment, as required. Results. Gastrointestinal symptoms were reported by 81 % of the patients, including 75,9 % with hypotonic-hypokinetic GB dysfunction. The six-minute walk test distance increased. After the PT course, the GB volume decreased from 37,5±2,7 to 27,3±2,1 ml in the MG, and did not change in the CG. GB dysfunction prevalence decreased by 62,7 % in the MG and increased by 3,1 % in the CG. Conclusion. In CHD patients after acute coronary events, the prevalence of GB dysfunction was 78,9 %. The longterm, moderate-intensity PH programme, combined with standard pharmaceutical therapy, improved EC, reduced angina attack incidence, and normalised GB motoric function and serum lipid profile in CHD patients with concomitant GB dysfunction.

Aim. То investigate the link between dynamics of QT and QTa duration and dispersion, corrected QT and QTa (QTc, QTac) in coronary heart disease (CHD) patients undergoing treadmill stress test, with ventricular arrhythmia registration. Material and metliods. In total, 77 patients with Functional Class II-FV angina were examined (mean age 51,1+8,1 years). All patients underwent treadmill stress test and coronary angiography. According to stress test results, two groups were identified: Group I (n=63) - without cardiac arrhythmias, and Group II (n=14) - with ventricular ectopic activity. Before and after stress test, QT, QTa, QTc, and QTac duration and dispersion were calculated. Results. During stress test, dQT and dQTc increased in both groups. In patients with ventricular arrhythmias, mean dQTa and dQTac decreased after stress test. In both groups, there was no significant difference in mean QT, QTc, QTa, or QTac duration before and after stress test. Conclusion. In CHD patients, ischemia-mediated dQT changes could be linked to terminal T wave variability. Reduced dQTa, as well as increased dQT, in stress test might reflect increased risk of ventricular arrhythmias in CHD patients.

Aim. To study dynamics of acute psychosis (АР) incidence and clinical features during reanimation period of acute myocardial infarction (AMI) treatment, according to ten-year data from a large specialized Cardiology Center. Material and methods. The study was based on the case history data of all AMI patients, treated at Reanimation and Emergency Care Department, Yekaterinburg Clinical Center «Cardiology» (YeCCC), in 1995-2004 (in total, 12 048 case histories). From these data, 473 histories were selected, with AP registered during reanimation period of AMI treatment. Results. In 10 years, AP incidence increased from 1.57% to 5.65%. AP was registered significantly more often in AMI patients aged over 60 years. Myocardial damage severity determined AP development in reanimation period of AMI treatment. There was a significant positive correlation between AP in reanimation period of AMI treatment and lethality, regardless of age and AMI size. Conclusion. A non-precedent (by data volume and, therefore, by observed correlations and differences' significance) study of AP development in reanimation period of AMI treatment, based on 10-year data from one of the largest Russian Cardiology Centers, was performed. The results point to the problem's actuality in modern cardiology practice, and to a need for timely AP diagnostics, prevention and therapy during reanimation period of AMI treatment.

Aim. To assess the antihypertensive effectiveness of perindopril and enalapril, as well as their effects on metabolic parameters, in patients with arterial hypertension (AH) and obesity (O). Material and methods. This blind, randomized, controlled, parallel comparative study included 60 patients with AH and O, who were administered perindopril or enalapril for 24 weeks. Results. Perindopril demonstrated significantly better antihypertensive effectiveness, cardio-, angio-, and nephroprotection, as well as an improvement in lipid, carbohydrate, and purine metabolism parameters. In patients with AH and O, only perindopril had beneficial effects on insulin resistance, hyperleptinemia, and inflammation. In contrast to enalapril treatment, perindopril therapy was associated with a marked improvement in anthropometry parameters and a reduction in fat tissue deposits. Conclusion. In patients with a combination of AH and O, perindopril was superior to enalapril in terms of antihypertensive effectiveness, organ protection, and the effects on key humoral factors determining body mass increase and blood pressure elevation.

Aim. To assess the effects of various antianginal nitrate therapy variants on quality of life (QoL) in patients with chronic coronary heart disease (CHD). Material and methods. In total, 259 patients were examined: 153 males (59,1 %) and 106 females (40,9 %); mean age 62,6±3,4 years. All participants had Functional Class II-IV effort angina and received antianginal therapy, QoL was assessed with Health-Related QoL scale. Results. In patients receiving retarded isosorbide-5-mononitrate forms (Group I), total QoL score increased from 3,5±0,3 to 7,4±0,25 during three-month follow-up; in participants receiving isosorbide-5-mononitrate and moderately prolonged isosorbide dinitrate (Group II), it increased from 3,3±0,3 to 6,1±0,2. Conclusion. During three-month follow-up, QoL improved significantly in Group I, and to a lesser extent in Group II.

Aim. To study intracardiac and pulmonary hemodynamics and arterial blood gases in patients with chronic stable angina pectoris associated with chronic obstructive pulmonary disease (COPD). Material and methods. The study included 103 patients: 49 people with Functional Class II chronic stable angina pectoris and COPD, plus 54 individuals with COPD only. Arterial blood gases, left and right ventricular (LV, RV) diastolic function (echocardiography with colour Doppler ultrasound), and right heart pressure levels (right heart and pulmonary artery (PA) catheterisation) were assessed. Results. The patients with chronic stable angina pectoris associated with COPD were characterised by progressing RV and LV diastolic dysfunction. In contrast to patients with isolated COPD, RV diastolic dysfunction was more pronounced in participants with combined pathology. In both groups, pulmonary hemodynamics was characterised by equivalent increases in systolic, diastolic, and mean PA pressure (Stage I). The manifestations of this increase were determined by the COPD stage. Conclusion. Combined cardio-respiratory pathology was characterised by progressing RV andLV diastolic dysfunction. In both groups, the factors with the strongest correlation with pulmonary hypertension included arterial hypoxemia, hypercapnia, and RV diastolic dysfunction.

Early treatment optimization improves clinical outcomes and reduces morbidity and mortality in patients with acute myocardial infarction (AMI). Intravenous beta-adrenoblocker (BAB) therapy, associated with improved survival, is well tolerated by AMI patients. The results of relevant clinical trials are presented. The causes of possible increase in cardiogenic shock risk for metoprolol group, COMMIT trial, are analyzed. Evidence base for early BAB therapy in AMI patients is presented.

Aim. To compare long-term results of coronary artery (CA) angioplasty and stenting, according to baseline CA stenosis morphology. To assess clinical course of coronary heart disease (CHD) during long-tem follow-up after endovascular intervention. Material and methods. During 1989-2005, 228 males with angioplasty and 184 males with non-eluted CA stents were recruited. One year later, 358 patients were examined, 5 years later - 273. Results. At five years after endovasular intervention, comparing to baseline and one-year results, the number of patients without angina symptoms substantially decreased, and the number of participants with angina increased. Long-term restenosis incidence was affected by initial CA stenosis morphology. In С Type, comparing to A Type, restenosis developed more often, by 2-2,5 times, regardless of endovascular intervention type. Conclusion. Choosing the therapeutic tactics in CHD, initial CA stenosis morphology should be taken into account. Stenting is more effective than angioplasty, especially in С Type pathology.