Aim. To evaluate the effectiveness of ambulatory secondary prevention among patients after myocardial infarction (MI). Material and methods. In total, 208 ambulatory medical histories of patients, examined at the cardiology dispanser and three polyclinics, were analysed. All patients, aged 45-75 years, previously had an MI, with or without Q wave (1 month — 1 year ago). In addition, all patients underwent clinical interview. Results. A very low level of non-pharmaceutical therapy compliance was observed. Every fourth cardiology dispanser patient and every second polyclinic patient were not compliant to dietary recommendations; 47 % and 35,2 %, respectively, had low physical activity, and every second male patient was a current smoker. Cardiology dispanser and polyclinic doctors prescribed anti-aggregants to 86 % and 75 % of their patients, respectively. For beta-adrenoblockers, the respective percentages were 86 % and 52,8 %, and for statins — 87 % and 21,3 %. Lipid profile assessment was regularly performed in 49 % of the cardiology dispanser patients. In 11 %, lipid profile was assessed irregularly, and in 40 % of the cases, only total cholesterol level was measured. Conclusion. The study results suggest low compliance of primary healthcare patients to non-pharmaceutical therapy. Polyclinic doctors demonstrated inadequate knowledge on pharmacotherapy potential in treating postMI patients.

Aim. To evaluate the knowledge of medical practitioners on total cardiovascular (CVD) risk assessment and ambulatory use of the SCORE instrument. Material and methods. In total, 229 medical practitioners from Russia and CIS countries participated in the anonymous survey: 72 % cardiologists and 26 % therapeutists. Mean age of the respondents was 44,6±11,7 years, with mean duration of working at the current position being 8,9±11,5 years. The survey questionnaire focused on the practical use of the SCORE risk assessment scale. Results. Ninety percent of the responders confirmed using the SCORE scale, 8,3 % were not using it, and 1,7 % did not know about the SCORE instrument. Among the SCORE components, 84 % of the practitioners correctly reported gender, age, blood pressure and total cholesterol; 75 % also correctly reported smoking; 40 % wrongly reported glucose and CVD in family history, while 30 % wrongly mentioned overweight, obesity, and waist circumference. Other risk factors (RFs) were wrongly reported by 6,6 % of the doctors (including education, reported by 3,3 %). Patients with diabetes mellitus and microalbuminuria, with three or more RF, or with total CVD risk >5 % were classified as having high total CVD risk by 80 % of the responders. Patients with confirmed CVD diagnosis were regarded as having high CVD risk by 67 % of the practitioners. Symptom-free patients with a very high level of a single RF were classified as having high CVD risk by 20 % of the responders only. Total CVD risk reduction, as a main goal of arterial hypertension treatment, was reported by 62 % of cardiologists and 58 % of therapeutists. Up to 54 % of the responders had RFs themselves. The interest in educational programmes for doctors, focusing on SCORE use in clinical practice, was very high (90 %). Conclusion. The study demonstrated inadequate knowledge of the practitioners on the methodology of total CVD risk assessment, an important instrument of primary prevention. The doctors attending medical educational programmes showed better levels of knowledge.

Aim. To study the effects of social factors (marital status, the number of children born and raised in the family) on the incidence of body weight (BW) increase. Material and methods. The 15-year follow-up focussed on BW dynamics in men and women, in regard to the changes in their martial status. At baseline, all participants were married (n=845; 327 men and 518 women). To evaluate the effects of the children’s number on increased BW incidence, 238 women aged 40—59 years and having at least one child before the baseline, were examined (≥ 2 children in 163 women, 1 child in 75 women). Increased BW was registered if body mass index (BMI) was 25 kg/m2 or higher. Results. In widowed participants, the incidence of BW increase was lower (1,9 %) than in those married (10,5 %; p<0,01) or divorced (21,4 %; p<0,01). In widowed women, the normalisation of initially increased BW was registered more often (13,5 %), compared to their still married peers (4,3 %; p<0,05). In those still married, BMI increased from 26,95±0,09 to 27,91±0,09 kg/m2 (p<0,001), while in those widowed, it decreased from 29,92±0,24 to 29,34±0,24 kg/m2 (p<0,05). In women with 2 or more children, the incidence of BW increase was higher (85,3 %) than in women with only one child (73,3 %; p<0,05). Conclusion. The change in marital status could affect BW dynamics. Spouse death is an important cause of BW reduction. In women with 2 or more children, increased BW was more common than in women with only one child.

Aim. To evaluate primary haemostasis parameters during two-month Zyllt therapy in patients with coronary heart disease (CHD) and gastric ulcer. Material and methods. In 60 patients with CHD, hyperlipidaemia, and gastric ulcer in remission, the effects of Zyllt (clopidogrel), in combination with lipid-lowering Vasilip (simvastatin) treatment, were investigated. Antiaggregant effects of Zyllt were assessed by measuring spontaneous and ADP-induced platelet aggregation at baseline, 5 days and 2 months after the therapy start. At baseline and in the end of the study, total blood cell count, lipid profile, and the levels of hepatic enzymes and C-reactive protein were examined. Results. Without the loading dose administration, the anti-aggregant effect of Zyllt was moderate at Day 5. In 37,2 % of the patients, all aggregation parameters were normalized, while in the other participants, they remained elevated. After 2 months of the treatment, aggregation parameters normalized in 78,7 %, and remained elevated in 20,7 % (n=12). Among these 12 individuals, no spontaneous aggregation was observed in 7, while ADP-induced aggregation substantially decreased, as a marker of Zyllt effects on its therapeutic target. In addition, Vasilip demonstrated good lipid-lowering effect in the study participants. Conclusion. Zyllt is an effective anti-aggregant, which is well-tolerated, without inducing hypocoagulation. In case of combined therapy, both lipid-lowering effect of Vasilip and anti-aggregant effect of Zyllt were observed. This combination did not result in hepatic or renal disturbances, or increased risk of cardiovascular events. The effectiveness of anti-aggregant therapy could be assessed by monitoring platelet aggregation.

Aim. To study the effects of the combined therapy with atorvastatin and polyunsaturated omega-3 fatty acids (omega-3 PUFA) on lipid profile, lipoprotein-associated phospholipase A2 (Lp-PLA (2)), and thromboxane B2. Material and methods. The study included 60 patients with coronary heart disease (CHD), randomised into two groups: Group I (n=29) receiving atorvastatin monotherapy; and Group II (n=31) receiving combined therapy with atorvastatin (10 mg/d) and omega-3 PUFA (1 g/d). At baseline, 12 and 24 weeks later, all participants underwent the assessment of lipid profile, serum levels of Lp-PLA (2), and plasma levels of thromboxane B2. Results. Adding omega-3 PUFA to atorvastatin therapy did not change the lipid-lowering action of the latter, with an exception of a greater triglyceride level reduction (-32 %; p=0,001 vs. the baseline). In both groups, six-month therapy was associated with a significant decrease in Lp-PLA (2) level (-33 % and -34 % for monotherapy and combined therapy groups, respectively; р=0,002 for both comparisons). Thromboxane B2 concentration decreased by 26 % (р=0,07) in Group I and by 62 % in Group II (р=0,02), compared to baseline levels. Conclusion. Combined therapy with atorvastatin and omega-3 PUFA was associated with decreased levels of atherogenic lipoproteins, Lp-PLA (2) and thromboxane B2, which can result in cardiovascular risk reduction.

Aim. To study bisoprolol effectiveness and safety in elderly patients with chronic obstructive pulmonary disease (COPD) and cardiac arrhythmias; to evaluate bisoprolol effects on bronchial resistance. Material and methods. All patients (n=65) were divided into 2 groups: Group I, receiving bisoprolol (n=34), and Group II (n=31), a control group not receiving beta-adrenoblockers (BAB). All participants underwent general clinical examination, 24-hour Holter ECG monitoring and lung function assessment by spirography. The titration of bisoprolol dose started from 2,5 mg/d. In case of no bradycardia, hypotension, or increased bronchial resistance, the dose was titrated up to 5 mg/d. The repeat examination was performed 12 weeks later. Results. BAB therapy was associated with a reduction in ventricular and supraventricular extrasystolia, including supraventricular tachycardia “runs” and atrial fibrillation paroxysms, among the majority of COPD patients. In the control group, on the contrary, the incidence of cardiac arrhythmias increased, compared to the baseline (p<0,05). In Group I, the following lung function parameters significantly increased by the end of the study: FVC (p<0,05), FEV1 (p<0,01), and FEF25% (p<0,05). In Group II, lung function parameters significantly increased, including FVC (p<0,05), FEV1 (p<0,01), FEF25% (p<0,01), and FEF50% (p<0,01). Conclusion. Bisoprolol did not increase bronchial resistance. Adding this highly selective BAB to a complex therapy of elderly patients with COPD resulted in cardiac arrhythmia correction, heart rate reduction, and quality of life improvement.

Aim. To study renal function and its association with cardiovascular risk factors in rheumatoid arthritis (RA). Material and methods. The study included 257 RA patients aged 29—69 years. Results. Reduced glomerular filtration rate (GFR) <60 ml/min was observed in 146 (56,8 %) RA patients. Renal dysfunction was associated with non-steroid anti-inflammatory drug (NSAID) therapy (OR 24,5; p<0,01), microalbuminuria (OR 17,8; p<0,01), high RA activity by DAS 28 (OR 6,1; p<0,01), pulse blood pressure (PBP) >55 mm Hg (OR 4,38; p<0,01), arterial hypertension (AH) (OR 3,15; p<0,01), atherogenic dyslipidemia (DLP) (OR 2,83; p<0,01), RA duration >10 years (OR 2,8; p<0,01), hyperglycaemia (OR 2,35; p<0,05), age >50 years (OR 2,17; p<0,01) and “non-dipper” BP profile (OR 1,85; p<0,05). GFR negatively correlated with vascular stiffness index (r=-0,23; p<0,01), LV myocardial mass index (r=-0,2; p<0,05), C-reactive protein level (r=-0,31; p<0,01), RA activity by DAS 28 (r=-0,29; p<0,01), age (r=-0,33; p<0,01), RA duration (r=-0,29; p<0,01), intima-media thickness (IMT) (r=-0,28; p<0,01), mean circadian systolic BP level (r=-0,19; p<0,05) and PBP level (r=-0,31; p<0,01), as well as SCORE-assessed cardiovascular risk level (r=-0,17; p<0,05). Conclusion. In RA, GFR reduction is a complication of chronic inflammation and long-term NSAID therapy. It is associated with AH, atherogenic DLP, and high cardiovascular risk.

Aim. To investigate the effects of enalapril on 24-hour proteinuria, renal function, intra-renal hemodynamics and survival, in regard to ACE gene polymorphism I/D, among patients with essential arterial hypertension (EAH). Material and methods. In total, 83 EAH patients were examined (mean age 41,48±1,25 years) as the main group (MG). The control group (CG) included 30 healthy people and was comparable to MG by gender and sex distribution. All participants underwent general clinical examination, assessment of 24-hour proteinuria and glomerular filtration rate (GFR), electrocardiography, echocardiography, renal ultrasound and renal vessel triplex scanning. ACE gene polymorphism was assessed by polymerase chain reaction method. Results. In EAH patients, D allele of ACE gene was associated, despite ACE inhibitor therapy during 4 years of the follow-up, with development of hypertensive nephropathy (HN), with an increase in 24-hour proteinuria from 276,67±112,13 to 836,50±294,50 mg/d, especially in individuals with DD genotype. The same group of patients developed renal failure: in 8 years, GFR decreased to 36,78±7,59 ml/min, while in patients with I allele, renal function was intact. Ten-year survival of EAH patients with DD genotype (all individuals developed renal failure) was significantly lower than in individuals with I allele. In EAH patients with II genotype, enalapril therapy resulted in vasodilatation and decreased resistivity and pulsatility indices, while no similar changes were observed in patients with DD genotype. Conclusion. Despite ACE inhibitor therapy, EAH patients with DD genotype were characterised by increased 24-hour proteinuria, reduced GFR, increased resistivity and pulsatility indices, and worse 10-year survival, compared to patients with I allele.

Background: Impaired coronary flow reserve (CFR) is a significant predictor of poor prognosis in patients with idiopathic dilated cardiomyopathy (IDC). Nebivolol reduces mortality and morbidity in patients with heart failure and left ventricular dysfunction, including cases caused by IDC. Objective: To assess the effects of nebivolol on CFR in patients with IDC. Methods: CFR was measured in the main group (MG), including 21 clinically stable patients with IDC (mean (SD) ejection fraction 35,7 (6,2)), at baseline and after 1 month of treatment with nebivolol once daily. A control group (CG) of apparently healthy subjects who were matched for age and sex was used for comparison. Resting and hyperaemic coronary flows were measured using transthoracic second-harmonic Doppler echocardiography. None of the subjects had any systemic disease. Results: After 1 month of treatment, heart rate (HR) was reduced significantly (p<0,001). The blood pressure (BP) was decreased significantly (p<0,001). The left ventricular end-diastolic diameter and stroke volume were not changed significantly, but end-systolic diameter was decreased significantly (p<0,05). Resting rate–pressure product was lower after treatment with nebivolol, but dipyridamole-induced change was not influenced by the treatment. Nebivolol treatment significantly reduced coronary velocities at rest (p<0,02) and also caused a significant increase in coronary velocities after dipyridamole (p<0,02), leading to a greater CFR (2,02 (0,35) vs. 2,61 (0,43); p<0,001). Nebivolol induced an absolute increase of at least 6% in the CFR in 17 of 21 patients (80,9%). Conclusions: In patients with IDC, 1 month of treatment with nebivolol induces a marked increase in CFR.

Aim. To compare clinical effectiveness of the long-term ambulatory therapy (bronchodilators; bronchodilators and fenspiride; bronchodilators, fenspiride and an ACE inhibitor perindopril) among patients with chronic obstructive pulmonary disease (COPD) and chronic cor pulmonale (CCP). Material and methods. In total, 132 patients with COPD and CCP were examined. All participants were divided into three groups, according to the administered therapy (see above), and underwent clinical examination, echocardiography (EchoCG), computed spirography, 6-minute walk test, and other procedures. The examination took place at baseline, as well as 12 and 24 months after the study started. Results. In COPD and CCP patients, long-term therapy with bronchodilators and fenspiride was associated with a significant decrease in bronchial obstruction syndrome severity, a substantial improvement in lung function (LF) and physical capability, and some improvement in EchoCG parameters, but did not influence mortality and chronic heart failure (CHF) progression. Adding an ACE inhibitor perindopril to the combined therapy resulted in a significant clinical improvement, even among the patients with severe COPD and decompensated CCP. Conclusion. Long-term treatment with a combination of inhaled bronchodilators, fenspiride, and an ACE inhibitor perindopril was highly effective and safe in patients with COPD and CCP, regardless of the disease severity.

Objective: To determine the safety and effectiveness of a calcium antagonist (CA) lercanidipine in the general practice settings. Material and methods: 110 patients with essential arterial hypertension (AH) were included in the study (mean age 62,3±10,8 years; 51 men, 53 women; 38% with obesity (O) and body mass index, BMI, >30 kg/m2; 10 with diabetes mellitus, DM). In total, 104 patients completed the follow-up protocol. All patients were treated with lercanidipine (10 mg once daily in the morning). General clinical, biochemical and instrumental examination was performed at each visit: at baseline, at Days 45, 90, and 180. When blood pressure (BP) was not controlled, a second antihypertensive drug was added (typically, antiadrenergic agents, but not CA), with additional examination in 30 days. If BP was not controlled by combined antihypertensive therapy, the patients were excluded from the follow-up. Results: Significant reductions in both systolic BP, SBP (baseline 157,4±11,7 vs. 131,1±6,8 mm Hg; p<0,001) and diastolic BP, DBP (baseline 94,7±5,8 vs. 80,0±5,5 mm Hg; p<0,001) were achieved. At the end of the study, mean SBP and DBP reductions were 26,7 and 15,6 mm Hg, respectively. In 84,3% of the patients, both SBP and DBP were controlled (<140/90 mm Hg). Thirty patients needed a second antihypertensive medication to control BP at the first visit, compared to 26 at the study end. The overall incidence of adverse effects was 4,4% (n=6). Only 3 patients withdrew from the treatment due to adverse effects. Plasma cholesterol (CH) level decreased from 225,3±41,0 to 216,7±25,3 mg/dl (p=0,03), and concentration of urates decreased from 5,6±1,6 to 5,1±1,4 mg/ dl (p=0,03). Conclusions: In general practice settings, a CA lercanidipine demonstrated high antihypertensive effectiveness and minimal incidence of adverse effects. An important aspect of its therapeutic potential is metabolic neutrality, confirmed by beneficial effects on plasma levels of CH and urates.

Aim. To analyse the causes of contrast-induced nephropathy (CIN) after coronary angioplasty (CAP), as well as the potential of long-term hemofiltration in CIN treatment. Material and methods. CIN risk was assessed by total score, as recommended by Barrett ВJ and Parfrey PS (2006). CAP with stent implantation was performed via femoral access, with hypoosmolar contrast ultravist 370. Hemofiltration was performed with the Diapact®CRRT device (substitution volume >30 ml/kg/h; Duosol® solution in bicarbonate buffer; heparin anticoagulation (10 U/kg/h) under activated clotting time control). Venous levels of hematocrit, K, Na, glucose, pH, bicarbonate, and lactate were controlled every 2-3 hours. Results. In a 71-year-old male patient with coronary heart disease (CHD) and post-infarction cardiosclerosis, the indications for CAP included myocardial ischemia and recurrent myocardial infarction (MI) risk. Concomitant diabetes mellitus was treated with novonorm and metformin. At baseline, serum creatinine level was 109 mkmol/l and glomerular filtration rate (GFR) — 50,5 ml/min/1,73 m2 , with moderate CIN risk. Balloon dilatation of circumference artery and blunt edge artery (BEA), obtuse marginal artery (OMA) stenting, OMA dilatation and stenting were performed. In total, 400 ml of contrast were used. Twenty-four hours later, creatinine level increase by 25 % was observed, with no effect from saline hydration. After 48 h, further increase in creatinine concentration, GFR <15 ml/min/1,73 m2 , and oligouria were observed. Long-term hemofiltration resulted in CIN regression. Conclusion. Long-term hemofiltration could have a crucial role in CIN treatment, in case of severe acidosis, oligouria, and GFR reduction <15 ml/min/1,73 m2 . Before the contrast administration, all necessary measures should be taken, to prevent CIN development.

The paper reviews the results of the studies demonstrating new potential of ACE inhibitors. The traditional clinical niche for ACE inhibitor therapy (arterial hypertension, heart failure, diabetic nephropathy) has been extended recently. Substantial vasoprotective effect of these medications has an important role in decelerating progression of atherosclerotic cardiovascular pathology. In addition, a differential assessment of protective effects, together with prognosis improvement among high-risk patients, is presented for various ACE inhibitors.

The ACT Study (Aspirin underutilization and compliance in Cardiovascular diseases Treatment; 2007-2008) was aimed at evaluating the doctors’ views on long-term, low-dose preventive therapy with acetylsalicylic acid (ASA), as well as at developing the strategy on improving patients’ compliance via a specialised questionnaire. The study took place in 18 European, Latin American, and Asian countries. Despite the fact that ASA therapy was recommended to >90 % of the patients after acute myocardial infarction, the treatment compliance was not adequate: for example, good compliance was observed only in 63 % and 54 % of European and Latin American patients, respectively. The most effective measures to increase the patients’ compliance, as reported by the participating physicians, were using the evidence on preventive effectiveness of long-term ASA therapy, and achieving a consensus between a doctor and a patient. Implementation of these measures requires good knowledge of evidence-based cardiology by the doctors, and more “democratic” doctor-patient relationship.

The effects of work stress on cardiovascular risk factors are reviewed. The specifics of workplace arterial hypertension diagnostics and target organ disease, as well as workplace arterial hypertension pathogenesis, are discussed.

This article is focused on actual and disputable points of use of beta-blockers for decrease of cardiovascular events in patients with arterial hypertension, ischemic heart disease, heart failure, diabetes mellitus and after non-cardiac surgical operations. Class of beta-blockers is very heterogeneous group of drugs which have different physical and chemical properties, various beta-receptor’s selectivity and additional characteristics. That is why the popular concept of “class-effect” seems not valid for this particular pharmaceutical class. The need for independent direct comparisons of different beta-blockers in randomised controlled trials is discussed.