Aim. To assess the effects of moxonidine in terms of target blood pressure (BP) achievement; to identify potential additional benefits of moxonidine and its effects on bone metabolism and bone mineral density (BMD) in postmenopausal women with arterial hypertension (AH).

Material and methods. The study included 48 postmenopausal women with Stage 1-2 AH, aged 57-71 years.

Results. All participants were divided into two groups by the type of antihypertensive therapy: those receiving moxonidine and those receiving angiotensin-converting enzyme inhibitors / angiotensin receptor antagonists (ACEI/ARA). All women also received calcium and vitamin D. All participants had AH and osteopenia (both in the lumbar spine and proximal femur, according to the X-ray absorptiometry results). In the moxonidine group, BP levels remained within the target range 48 weeks later. There was a significant reduction in the levels of a bone resorption marker (p=0,041), while the dynamics of an osteopoetic marker was statistically non-significant (p=0,31). A tendency towards increasing BMD in lumbar spine and proximal femur was also observed (p=0,059 and p=0,068, respectively). In the ACEI/ARA group, BP levels also remained within the target range 48 weeks later. However, no significant changes in the levels of bone metabolism markers were registered. There was a tendency towards decreasing BMD in lumbar spine and proximal femur (p=0,052 and p=0,054, respectively).

Conclusion. Moxonidine therapy was associated with a significant reduction in bone resorption activity, as demonstrated by the decrease in the concentration of a bone resorption marker, as well as with a tendency towards increasing BMD.

Aim. To assess effectiveness and safety of a new rehabilitation method — interval hypoxia-hyperoxia training (IHHT) — in patients with chronic coronary heart disease (CCHD).

Material and methods. This pilot study included 40 CCHD patients, Functional Class II–III (31 men and 9 women; mean age 61,7±7,7 years). The IHHT group (n=30) underwent 20 procedures (duration 40–50 minutes, 5 times a week), while the control group (n=10) underwent 20 similar placebo procedures. The REOXY device (AIMediqS.A., Luxemburg) was used for the creation of the gas mixtures with O2 content from 10% to 35–40%. At baseline and in the end of the treatment, individual hypoxia sensitivity was assessed in a 10-minute hypoxic test (HT). The IHHT procedure started with 5–7 minutes of mask inhalation of 12–11% О2, followed by 2–3 minutes of mask inhalation of 30% O2. The automatic switch between the gas mixtures followed the biological feedback principle; one procedure included 6–8 hypoxiahyperoxia cycles. Before and after the intervention phase, all participants underwent clinical and biochemical blood assay, rest ECG, submaximal treadmill test (time of the test, workload, and exercise capacity in metabolic equivalent units (MET)).

Results. After the IHHT course, the main group demonstrated a significant increase in exercise capacity: test time increased by 34,1% (vs. —2,7% in controls), while exercise capacity (MET) increased by 15,8% (vs. 5,4% in controls), and the prevalence of angina attacks as the result of test termination significantly decreased. Improved exercise capacity was associated with a significant reduction in total cholesterol, plasma triglycerides, initially elevated blood pressure and resting heart rate, as well as with an elevated hypoxia tolerance threshold in the HT. In all participants, IHHT was well tolerated and free from adverse effects. Conclusion. The IHHT method increases exercise capacity in CCHD

patients, which is associated with lipid profile normalisation, blood pressure reduction, decreased number of angina attacks, and increased resistance to hypoxia.

Aim. To investigate the clinical specifics of acute myocardial infarction

(AMI) in patients with chronic tonsillitis.

Material and methods. The study included 70 patients at early AMI stages (Days 1–2). The following parameters were analysed: anthropometry, blood biochemistry, myocardial necrosis markers, QT interval dispersion, echocardiography and Holter ECG monitoring parameters, and a confirmed medical diagnosis of chronic tonsillitis in medical history.

Results. In 31 patients with confirmed chronic tonsillitis, higher body mass index values, a significantly higher incidence of acute heart failure (19,4%; p<0,05) and anterior AMI (70%), higher glucose levels at admission (7,58±0,62 mmol/l), and a higher end-diastolic size of right ventriculum (3,04±0,19 cm vs. 2,66±0,05 cm) were observed. Mean daytime and peak nighttime heart rate values were higher than in other patients.

Conclusion. Patients with confirmed chronic tonsillitis were characterised by a more severe clinical course of AMI. There is some evidence that chronic tonsillitis is also associated with metabolic syndrome.

Aim. To assess the effectiveness of Mildronate in the prevention of arrhythmias during the perioperative period of open cholecystectomy under intravenous multicomponent anesthesia.

Material and methods. In total, 69 patients were divided into 3 groups: with concomitant coronary heart disease (CHD), with essential arterial hypertension (EAH), or without concomitant cardiovascular disease (CVD). Each group was divided into a control subgroup (total n=36) receiving conventional treatment and a main subgroup (total n=33) additionally receiving Mildronate (500 mg twice a day intravenously: 24 hour before the operation, during premedication, during early postanesthetic period, and for 2 days after the operation). Arrhythmic episodes were registered at Holter ECG monitoring for 4 days: 24 hours before the operation; 24 hours of the operation; and 48 hours after the operation. The monitoring period was divided into 6 intervals: 1 — preoperation; 2–6 hours before the operation; 3 — anesthesia start; 4 — anesthesia maintenance; 5 — anesthesia finish; and 6 — second day after the operation.

Results. Cardiac arrhythmias were registered not only among patients with EAH and CHD, but also with patients without concomitant CVD.

Conclusion. Mildronate therapy reduced the number of arrhythmic episodes at different stages of perioperative period, particularly in the anesthesia start, finish, and maintenance periods among patients with CHD and EAH, as well as among CVD-free patients.

Aim. To assess the role of vasomotor dysfunction and impaired flowdependent vasodilatation as a risk factor of silent myocardial ischemia (SMI) in patients with Type 2 diabetes mellitus (DM-2).

Material and methods. The study included 128 patients (66 men and 62 women; mean age 59,3±4,7 years), who underwent Holter ECG monitoring, stress test (Bruce protocol), echocardiography, vascular ultrasound, and brachial artery endothelium-dependent vasodilatation (EDVD) assessment.

Results. Patients with coronary heart disease and DM-2 demonstrated reduced EDVD levels (3,7±1,1%) and highly prevalent SMI (93,3%). There was a correlation between EDVD and the number (r=–0,68; p<0,05) or duration of SMI episodes (r=–0,53; p<0,01).

Conclusion. Patients with DM-2 require the assessment of vasomotor endothelial function in order to predict cardiovascular complications. Coronary artery endothelial dysfunction, which manifests in inadequate vasodilatation in response to increased myocardial demand for oxygen, plays an important role in the ischemia development and progression.

Aim. To study the clinical potential and feasibility of the assessment of cardio-ankle vascular index (CAVI) at medical prevention departments and units.

Material and methods. The study included 66 patients (13 men and 53 women; mean age 52,26±11,2 years) with very low to very high total cardiovascular risk (CVR) levels and SCORE index 0–25% (mean SCORE index 3,18±4,34%), who underwent volume sphygmography and automatic CAVI measurement.

Results. There was a moderately strong, statistically significant correlation between CAVI and age; CAVI and systolic blood pressure (SBP); and CAVI and SCORE. While higher CAVI values were observed among non-smokers and patients with arterial hypertension, these differences were not statistically significant.

Conclusion. As a method for arterial stiffness assessment, CAVI measurement is easy to perform, does not require any special preparation, and can be used at medical prevention departments and units as a part of a more detailed preventive examination. A moderately strong, statistically significant correlation was observed between CAVI and SCORE, as well as between CAVI and such SCORE components as age and SBP. However, further research is needed in order to clarify the possibility of CAVI inclusion in prognostic models.

The current status of obesity (O) as a global problem justifies the use of the term “obesity epidemic”, since the prevalence of O has increased substantially, in contrast to the decreasing prevalence of other risk factors (RFs).

Aim. This analysis assessed the all-cause (AC) and cardiovascular disease (CVD) mortality levels by body mass index (BMI) in a middleaged Russian population.

Material and methods. The present analysis included the data from seven studies performed by the State Research Centre for Preventive Medicine in 1975–2001. The total number of participants was 17821: 12887 men and 4934 women, aged 35–74 years. All participants were examined following the same protocol. The following parameters were analysed: socio-demographic and behavioural characteristics, lipid and carbohydrate metabolism disturbances, and clinical parameters. All participants were divided into seven categories by their BMI values: from BMI <21 kg/m 2 (first category) to BMI ≥36 kg/m 2 (sixth category). Results. There were positive associations between BMI and systolic blood pressure, diastolic blood pressure, triglycerides, and coronary heart disease presence. At the same time, BMI was negatively associated with smoking and excessive alcohol consumption. No associations were observed for BMI and left ventricular hypertrophy, heart blocks, or cholesterol levels. After adjustment for age, there was a U-shaped association between BMI and AC mortality. With the category “BMI <21 kg/m 2” as a reference group, mortality risk levels were decreasing for the second and third BMI categories, with an increased risk for the sixth category. In women, age-adjusted relative risk (RR) of AC mortality was only slightly lower than that in men. After additional adjustment for RFs and clinical parameters, RR of AC mortality was relatively similar across all BMI categories in both genders, without any significant differences compared to the reference group. Among lower BMI categories in men, RR of CVD mortality was close to RR for AC mortality. However, in higher BMI categories, the former was substantially higher than the latter. No similar patterns were registered for women.

Conclusion. The observed tendency of elevated CVD risk in people with O suggests that particular attention should be paid to this risk factor. Adverse effects of O have also been demonstrated for people with arterial hypertension and diabetes mellitus. For the latter, its prevalence has substantially increased in Russia over the past years.

Aim. To study the association between cardiovascular disease (CVD) mortality levels in men and day of the week, season of the year, and change to daylight saving time.

Material and methods. This prospective study included the 13-year follow-up data for 2390 men aged 15 years and older.

Results. The overall level of CVD mortality in men was 407,1 per 1000, with no associations with day of the week, season of the year, or change to daylight saving time. However, in the spring, the highest and lowest levels of CVD mortality were observed, respectively, on Thursday (21,2 per 1000) and Sunday (10,6 per 1000). In the autumn, the highest and lowest levels of CVD mortality were observed on Sunday (21,1 per 1000) and Monday (7,9 per 1000), respectively. The proportion of men dying from CVD on Monday was twice as high in the winter (33,3%, or 17,8 per 1000) than in the autumn (14,8%, or 7,9 per 1000). The proportion of men dying from CVD on Sunday was twice as high in the autumn than in the spring (38,1%, or 21,2% per 1000 vs. 19,0%, or 10,6 per 1000, respectively).

Conclusion. The observed dynamics of CVD mortality during the week and across the seasons should be taken into account by the CVD prevention programmes.

The paper reviews the clinical practice potential of a combined action antihypertensive medication urapidil for the treatment of patients with acute elevation of blood pressure (BP) and confirms urapidil effectiveness and good tolerability. Urapidil action mechanisms, pharmacodynamics, and pharmacokinetics are discussed, together with the results of the key clinical trials which have demonstrated antihypertensive effectiveness and safety of this agent. Additional beneficial effects of urapidil, such as reduction of the increased pulmonary artery BP and improvement of bronchial conductivity, are also described.

The paper focuses on the justification for preferential administration of antihypertensive combination therapy. Pharmacotherapeutic features of starting the treatment with a combination of angiotensin-converting enzyme inhibitors (ACEI) and calcium antagonists (AC) are reviewed. The authors also present the latest evidence on the ACEI/AC combination effects on such vascular parameters as microcirculation and endothelial dysfunction.

Atrial fibrillation (AF) is one of the most pertinent problems in internal medicine, primarily due to its severe thrombotic complications, such as stroke, myocardial infarction, pulmonary artery and thromboembolism, and their medical and economic consequences. This emphasises the importance of the detection of risk factors relevant to prognosis and of the effective and safe long-term preventive treatment with anticoagulants, particularly for ambulatory patients. At the moment, the focus is on the so-called new oral anticoagulants which demonstrate a range of benefits, compared to indirect anticoagulants.

The paper reviews the modern literature on the role of dietary lipids in the development and control of hypercholesterolemia, as a diet-dependent cardiovascular risk factor. The author presents historical evidence and the position of leading medical professional bodies on the use of diets with different lipid components in primary and secondary prevention of coronary heart disease. The paper also discusses the results of original studies and meta-analyses on the importance of fatty acids of different chain length, configuration, and saturation for the levels of cardiovascular risk.