Aim. To compare therapeutic and diagnostic measures, as well as the incidence of cardiovascular events (CVE), during hospitalization, one-year and five-year follow-up period among the patients with acute coronary syndrome without ST segment elevation (non-STE ACS), who were urgently hospitalized to a therapy department of a large multi-field hospital, or to a specialised cardiology department. This comparison was aimed at identifying the methods for further medical service optimization. Material and methods. This retrospective, historical cohort study included 350 consecutive medical histories of non-STE ACS patients, urgently hospitalized to the urgent cardiology department (Research Institute of Cardiology, Siberian Branch, Russian Academy of Medical Sciences), and 370 medical histories of the patients hospitalized to the therapy department (City Hospital No. 1). Results. In the therapy department, non-STE ACS patients received fewer diagnostic and therapeutic procedures than in the cardiology department, due to limited resources. The risk levels at in- and out-patient treatment stages were not assessed adequately, which resulted in a higher incidence of adverse outcomes throughout the follow-up period. Original clopidogrel was administered to 6 % and 0 % of the cardiology and therapy department patients, respectively. Since there is no statistically significant difference in hard outcomes between original and generic clopidogrel (Zyllt), the latter could be recommended to ACS patients. Conclusion. Non-STE ACS patients with high risk should be referred to specialised cardiology hospitals, where invasive diagnostic and treatment (percutaneous coronary intervention) could be performed. High effectiveness and good safety profile should improve Zyllt treatment compliance in most patients after ACS and/or revascularization.

Aim. To investigate the gender differences in reperfusion therapy use among patients with ST segment elevation myocardial infarction (STEMI). Material and methods. The in-hospital therapy was assessed in 343 men and 186 women with STEMI. Results. There were significant differences in reperfusion rates among male and female patients. In total, reperfusion was performed in 265 men (77,2%) and 105 women (56,4%; р<0,05). Over 50% of the male patients underwent percutaneous coronary intervention (55,6%), in contrast with 39,2% of the female patients (р<0,05). The reason for this difference could be not gender per se, but co-existing diabetes mellitus, late diagnostics of acute coronary syndrome (ACS), and older age (over 70 years), which were more prevalent in women. Conclusion. Women with ACS are in need for more effective diagnostics and treatment.

Aim. To analyze the dynamics of heart structure, geometry, and function in women, in accordance with present components of metabolic syndrome (MS). Material and methods. In total, 245 women, comparable by age and blood pressure (BP) levels, were examined: with arterial hypertension (AH), but without dyslipidemia (DL) or obesity (O) (control group, CG; n=100); with AH and DL, but without O (Group 1; n=37); with AH, DL, abdominal O (mean waist circumference, WC, 104,84±15,92 cm), but without carbohydrate metabolism disturbances (Group 2; n=93); with AH, DL, abdominal O and impaired glucose tolerance, IGT (Group 3; n=15); with AH, DL, abdominal O and new-onset Type 2 diabetes mellitus (DM-2) (Group 4; n=22). All participants underwent echocardiography, with the assessment of left ventricular (LV) remodelling indices, oral glucose tolerance test, and serum lipid profile assessment. Results. DL did not demonstrate an independent role in heart structural and functional changes. In women with MS and impaired carbohydrate metabolism (IGT or DM), remodelling was a manifestation of disadaptation. In these patients, increased body mass index (BMI) and plasma glucose levels were associated with impaired systolic function (increased systolic myocardial stress, reduced ejection fraction, and earlier development of heart failure). Conclusion. In women with various combinations of MS components, heart structure and function changes are different. Insulin resistance facilitates the progression of systolic myocardial stress and myocardial contractility reduction. Increased levels of BMI, serum glucose and glycated hemoglobin were associated with impaired systolic function and earlier development of heart failure in women with MS.

Aim. To investigate the atherogenic role of postprandial hyperlipidemia (PPH) and endothelial dysfunction (ED) in the development of coronary angiosclerosis in patients with coronary heart disease (CHD) and metabolic syndrome (MS); to study the effectiveness of rosuvastatin in the correction of these factors. Material and methods. The first study phase included 18 CHD and MS-free participants (control group, CG) and 52 patients with CHD and MS. Based on the coronary angiography (CAG) results, the patients with CHD and MS were divided into 2 groups: Group I (n=27) with moderate coronary artery (CA) stenosis (1-4 points), and Group II (n=25) with severe CA stenosis (5-16 points). All participants received a standard lipid load (LL), and peripheral artery reactivity was assessed by photoplethysmography at fasting state and 6 hours after LL. The second study phase included 21 patients with CHD and MS, to investigate the effects of rosuvastatin (10 mg/d) on fasting and PPH and ED. Results. The results of the first study phase demonstrated that in controls and patients with CHD and MS, LL resulted in different types of PPH. In Groups I and II, but not in controls, substantial and long-lasting PPH manifested in increased levels of triglycerides (TG) and low-density lipoproteins (LDL), as well as in decreased levels of high-density lipoproteins (HDL). In addition, decreased endothelial function (EF) was observed in all three groups, with vasospastic reaction in Groups I and II. Rosuvastatin therapy improved the fasting and postprandial levels of total cholesterol (TCH), TG, LDL, and also improved endothelium-dependent vasodilatation 6 hours after LL. Conclusion. PPH phenomenon is characterised by high atherogenic potential and linked to peripheral artery ED and coronary angiosclerosis. Photoplethysmography is a non-invasive, reliable method for identifying the patients with severe CA stenosis. Rosuvastatin therapy (10 mg/d) improves fasting and postprandial lipid levels, as well as postprandial EF.

Aim. To evaluate the effects of myocardial cytoprotectors on the levels of apoptotic endotheliocytes and membranederived microparticles of endothelial origin in peripheral blood of the patients with cardiovascular disease (CVD). Material and methods. The study included CVD patients with arterial hypertension (AH) and coronary heart disease (CHD) or AH only, all of whom gave informed consent. The control group (CG) included patients with neuro-circulatory dystonia (NCD). In all participants, peripheral blood samples were taken at baseline and after 3 weeks of trimetazidine MR therapy, to assess the levels of endotheliocytes and membrane-derived microparticles. Results. Trimetazidine MR treatment resulted in significantly reduced levels of apoptotic endotheliocytes and membrane-derived microparticles in the two main groups and the CG (p<0,05). Conclusion. Trimetazidine MR could be used as pathogenetic therapy, correcting vascular wall homeostasis in CVD patients, and also as prevention of endothelial dysfunction progression in NCD patients.

Aim. To study the cross-sectional prevalence of overweight (OW) in men and women, in regard to their spouses’ body weight (BW), as well as to assess the BW dynamics in participants and their spouses over 15 years of the prospective follow-up. Material and methods. In the screening study, body mass index (BMI) was assessed in 425 married couples. The repeat assessment, performed 15 years later, included 232 couples who were still married. OW was diagnosed in subjects with BMI ≥25 kg/m2. Results. In the wives of OW men, OW prevalence was higher (76,2%) than in the spouses of non-OW men (61,3%; p<0,001). In the husbands of OW women, OW prevalence was also higher (61,3%) than in the spouses of non-OW women (43,8%; p<0,001). In the prospective study, the participants with no OW at baseline, whose spouses developed OW, the incidence of OW was significantly higher (60,9%) than in participants whose spouses remained non-OW (16,4%; p<0,001), or in participants whose spouses remained OW (31,7%; p<0,05). Among men and women with OW at baseline, whose spouses reduced their BW and became non-OW, BW normalization was more frequent (32,0%) than in the participants whose spouses either remained OW (9,1%; p<0,001), or remained nonOW (3,4%; p<0,001), or increased BW and became OW (6,9%; p<0,05). Conclusion. BW dynamics in spouses was characterized by parallel increases or decreases, due to shared social and intra-familial factors.

Aim. The TOLERANCE study was aimed to compare the tolerability of high doses of lercanidipine (20 mg) with that of other frequently used dihydropyridines (amlodipine 10 mg/nifedipine GITS 60 mg) in the treatment of essential hypertension (EAH) in daily clinical practice. Material and methods. It was an observational, transversal, multicentre study performed in a Primary Care Setting. A total of 650 patients with EAH and age ≥18 years were included. They had been treated with high doses of lercanidipine (n=446) or amlodipine/nifedipine GITS (n=204) during at least 1 month and previously with low doses (10 mg, 5 mg, and 30 mg, respectively) of the same drugs. Results. The main objective was to compare the rates of vasodilation-related adverse events (AE) between both groups. Rates of signs and symptoms related to vasodilation were significantly higher (p<0,001) in the amlodipine/nifedipine GITS group (76,8%, CI 95% [70,7;82,9]) than in lercanidipine group (60,8%, [56,1;65,5]). Blood pressure control (<140/90 mm Hg or <130/80 for diabetics) and type of concomitant antihypertensive medications were similar in both groups. Treatment compliance was good (~93%) and fairly comparable in both groups. Most AE with lercanidipine were mild (74,5% vs. 64% in amlodipine/nifedipine GITS group, p=0,035) whereas severe AE rates did not differ significantly between groups (2,8% vs. 3,6%). Conclusion. In conclusion, treatment with lercanidipine at high doses is associated with a lower rate of AE related to vasodilation compared to high doses of amlodipine or nifedipine GITS in clinical practice.

Aim. The Multicentre Olmesartan atherosclerosis Regression Evaluation (MORE) study was a double-blind trial in patients with hypertension at increased cardiovascular risk with carotid wall thickening and a defined atherosclerotic plaque that used non-invasive 2- and 3-dimensional (D) ultrasound (US), to compare the effects of a 2-year treatment based on either olmesartan medoxomil or atenolol on common carotid (CC) intima-media thickness (IMT) and plaque volume (PV). Methods. A total of 165 patients (with systolic/diastolic blood pressure 140–180/90–105 mm Hg) were randomized to receive either olmesartan (20–40 mg/day) or atenolol (50–100 mg/day). US was performed at baseline and 28, 52 and 104 weeks. The primary efficacy outcome was the change from baseline (Δ) in CC-IMT assessed by 2D US. Secondary outcomes included ΔPV assessed by 3D US and blood pressure (BP). Results. Olmesartan and atenolol produced comparable significant reductions in CC-IMT; mean ΔIMT (SEM) was −0,090 (0,015) mm for olmesartan and −0,082 (0,014) mm for atenolol. Mean ΔPV was −4,4 (2,3) μl and 0,1 (1,5) μl in the olmesartan and atenolol treated subjects, respectively, without significant between-treatment differences. In the subgroup of patients with baseline PV ≥ median (33,7 μl), significant between-treatment differences existed in ΔPV (p=0,023), because PV regressed significantly with olmesartan (ΔPV: −11,5 (4,4) μl) but not with atenolol (ΔPV: 0,6 (2,5) μl). In these patients BP reductions were comparable. Conclusion. Carotid IMT and BP decreased similarly with olmesartan and atenolol, but only olmesartan reduced the volume of larger atherosclerotic plaques.

The paper reviews the modern evidence on mechanisms of action and clinical effectiveness of two cardiovascular medication classes – angiotensin-converting enzyme (ACE) inhibitors and calcium antagonists (CA), used for the treatment of patients with arterial hypertension (AH) and coronary heart disease (CHD). ACE inhibitors and CA have complementary effects on vascular tone and endothelial function, as well as synergetic action in terms of blood pressure (BP) reduction, pleiotropic effects, organo-protection, and clinical event prevention. Therefore, these mediations can be used as combined cardiovascular therapy. Perindopril and amlodipine, both as monotherapy or combined treatment, have the largest evidence base and potential for clinical practice.

The review presents the modern views on the mechanisms resulting in endothelial dysfunction, macro- and microangiopathy among patients with diabetes mellitus (DM). The role of nitric oxide (NO) in these mechanisms, NO input in the pathogenesis of vascular DM complications, and the effects of DM-related metabolic disturbances on NO bioavailability are discussed.

The paper discusses the modern state of the mitral valve prolapse (MVP) problem. Controversial and unresolved issues on terminology, diagnostics, and tactics for different MVP variants are considered on the basis of the “Heritable disorders of connective tissue” recommendations (2009) by Expert Committee, the Society of Cardiology of the Russian Federation (VNOK). The modern diagnostic criteria of MVP are discussed, as well as echocardiography-estimated MVP prevalence while using those diagnostic criteria, and the comparison of Framingham Heart Study results to the authors’ own data. The interrelation between autonomic dysfunction and MVP is assessed, and different approaches to the stratification of MVP complication risk are compared, based on the echocardiography results and clinical data. The modern methods of MVP treatment and management strategy are also described.

The paper discusses modern views on myocardial damage mechanisms in coronary artery bypass surgery (CABG). The publications reviewed include those on molecular basis and pathophysiological pathways in ischemia/ reperfusion syndrome, as well as on potential cardioprotective strategies.

The paper discussed the causes of the substantial geographical discrepancies in the rates of cardiosurgery interventions, based on the secondary analysis of international data. The impact of these differences on mortality levels is assessed. The methods for population demand assessment are reviewed, with the focus on the intervention rates across the countries and the “number needed to treat” parameter.

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.

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.