Aim. To assess coronary heart disease (CHD) and its risk factors (RF) prevalence, as well as their interaction in patients with heterozygotic form of familial hypercholesterolemia (FHCH). Material and methods. The analysis included 200 patients aged 24 years and above, with clinical diagnosis of FHCH. Cardiovascular status, RF type and prevalence were studied in patients with and without CHD. Multivariance analysis was performed to determine the link between RF and CHD development. Results. CHD prevalence in non-treated FHCH was as high as 61,5%. CHD rates increased with age, and were greater in males. CHD patients were older and had more adverse RF profile. Myocardial infarction was registered in 31% of the patients: for males - 18,1%, for females - 48,8% (р=0,00001). According to coronaroangiography data, coronary lesion number was similar in both genders, but in males occlusion severity was greater. In arterial hypertension (AH) multivariance analysis, CHD was the most important RF in FHCH patients. High blood pressure, combined with MTHFR CC genotype, increased CHD risk by 6,3 times, and AH-free combination of VII coagulation factor QQ genotype with GpIIIa CC genotype increased CHD risk by 8 times. Without treatment, male and female survival was substantially low in families with FHCH, especially for males. Conclusion. CHD is a typical feature of non-treated FHCH, developing earlier in males. In FHCH patients, CHD predictors include not only traditional RF, but also their combinations with genetic protein variations, not related to lipid metabolism.

Aim. To investigate lipid profile, lipoprotein (a) [Lp(а)] and apolipoprotein В-100 (apo В-100) levels in coronary heart disease (CHD) patients. To identify significant CHD predictors and their association with cholesterol (CH) and triglyceride (TG) levels. Material and methods. In total, 575 patients (main group), aged 66,56±12,51 years, with verified CHD were included, as well as 86 individuals (control group), aged 55,47±11,47 years, without cardiovascular disease (CVD). Results. Levels of apo B-100 – 128,17 mg/dl (р<0,00001) and Lp(a) – 27,6 mg/dl (р<0,007) were significantly higher in all CHD patients than in control group. Lp(a) level was significantly higher in acute coronary syndrome (ACS) patients, comparing to control group (р<0,02). Increased apo B-100 leve, 130,9±46,5 mg/dl was a significant (р<0,00001) risk factor (RF) for ACS in CHD patients. There was a significant correlation between Lp(a) (р<0,00003) or apo B-100 (р<0,00001) levels and CH or TG concentrations in CHD individuals. Conclusion. Lp(a) and apo B-100 levels were significant RF for CHD (including acute myocardial infarction) development. Maximal concentration of Lp(a) was observed in CHD patients with hypercholesterolemia (HCH); maximal apo B-100 level – in CHD and hypertriglyceridemia participants.

Aim. To study lipid peroxidation (LP), pro-oxidant status, and antioxidant protection in coronary heart disease (CHD) patients with stable angina and post-infarction cardiosclerosis, who underwent coronaroangiography (CAG). Material and methods. The study included 32 CHD patients with Functional Class II-III angina, who underwent CAG, and 22 relatively healthy controls. Before CAG, plasma levels of lipids, PL products, uric acid, ceruloplasmin (CP), transferrin (RF) and methemoglobin (electron paramagnetic resonance), homocysteine (highly effective liquid chromatography), superoxide dismutase (SOD) and glutathione peroxidase (GP) in red blood cells were measured. Results. In CAG, severe coronary artery pathology was registered: occlusions of at least 70% comprised 63,7% of the total stenosis rate. Severe lipid metabolism and PL disturbances, as well as decrease in tissue and plasma antioxidant enzymes (SOD by 10%, GP by 46%, CP/TF by 33%) – were observed, comparing to the control group. There was a direct correlation between coronary artery stenosis rate and age (r=0,4) or levels of total cholesterol, low-density lipoprotein cholesterol (r=0,3), and PL product, MDA (r=0,34). Inverse correlation between stenosis number and antioxidant enzyme levels was also registered in CHD patients for SOD (r=-0,5), GP (r=-0,3), and CP/TF (r=-0,3). Conclusion. Coronary artery atherosclerosis severity was affected by tissue and plasma antioxidant enzyme levels, as well as by LP manifestation.

Aim. To study rosuvastatin safety and effects on lipid profile (LP) in coronary heart disease (CHD) patients. Material and methods. The study included 30 males (mean age 57±9 years) with diagnosed CHD, Functional Class II-III stable effort angina, receiving adequate basic therapy. In all participants, initial total cholesterol (TCH) level was >5,2 mmol/l. At baseline and after three weeks of rosuvastatin therapy (10 mg/d), general and biochemical blood assays were performed, to measure LP, AST, ALT, creatine kinase (CK), glucose, total bilirubin (BR) and creatinine levels. Results. Three-month rosuvastatin therapy improved blood LP: TCH, triglyceride (TG) and low-density lipoprotein CH (LDL-CH) levels significantly reduced, and high-density lipoprotein CH (HDL-CH) level increased. In general, levels of TCH decreased by 31%, TG – by 39%, LDL-CH – by 44%, and HDL-CH level increased by 6%. Target TCH level was achieved in 17 participants (57%), and target LDL-CH level – in 23 patients (77%). Throughout the study, no adverse reactions (hepatic enzymes, CK, BR, or glucose level increase) were observed. Conclusion. Rosuvastatin did not increase rhabdomyolysis or myopathy risk. Rosuvastatin therapy helped to achieve significant decrease in TCH and LDL-CH levels.

Aim. To study perspectives of reducing incidence and severity of coronary artery (CA) restenosis by adding a low dose of antioxidant agent Probucol (250 mg/d) to the treatment before and after transluminal balloon coronary angioplasty (TBCA). Material and methods. The study included 81 patients (mean age 55±6,5 years in Probukol group; 53±6 years in control group; total cholesterol (TCH) level – 6,2±0,66 mmol/l and 6,77±0,79 mmol/l, respectively) with chronic coronary heart disease (CHD), who underwent TBCA and coronaroangiography (CAG) 6 months later. The angiograms were assessed by quantitative computer analysis. Results. In atherosclerosis patients, antioxidant agent Probucol was highly effective not only in the lipid-lowering dose (1000 mg/d), but also in a four-fold reduced dose (250 mg/d). After six-month Probucol treatment (250 mg/d), restenosis incidence was just 19%, comparing to 28% in the control group. In Probucol group, minimal CA lumen diameter was significantly greater, and CA stenosis severity – significantly lower than in control group. Conclusion. The results obtained proved the possibility to reduce restenosis severity by Probucol treatment, even in low dose (250 mg/d), without affecting lipid profile.

Aim. To identify new, non-traditional risk and precipitating factors, that, combined with chronic chlamydial and viral infection, could provoke coronary atherosclerosis destabilization and acute coronary crise development. Material and methods. In total, 66 coronary heart disease (CHD) patients were examined, who had stable effort angina or acute coronary syndrome (ACS), and were sero-positive for Chl. Pneumoniae, HSV-I, CMV and EBV viruses. Control group included 20 sero-negative CHD patients. Serological status was determined by ELISA immuno-enzyme method. Results. Triad of plasma markers: C-reactive protein (CRP), МВ-creatine kinase, and lipid hydroperoxide activity – was identified, that can be used, together with serological status data, for more effective ACS diagnostics. Conclusion. Recurrent infection might play a role as one of the triggers for chronic CHD transformation into its acute or instable forms.

Aim. To study antiaggregant therapy effects in patients with instable angina (UA) and non-Q wave myocardial infarction (non-Q MI). Material and methods. This randomized, open, comparative study included 78 patients with Class IIID UA and non-Q MI. Group I (n=17) did not receive any antiaggregants; Group II (n=26) was administered aspirin (250 mg/d at admission, then 125 mg/d); Group III (n=17) received cardiomagnil (150 mg/d, then 75 mg/d); Group IV (n=11) was treated with clopidogrel (75 mg/d) and cardiomagnil (75 mg/d) combination. ADP and adrenalininduced platelet aggregation (PA) was measured with a laser platelet aggregation analyzer 230-LA. All participants received subcutaneous fraxiparin (86 IU/kg every 12 hours). Results. In Group I, hyperPA was observed. In Group II, 6 patients out of 26 demonstrated aspirin resistance. In aspirin-sensitive participants, ADP-induced PA decreased only slightly, and adrenalin-induced PA was significantly suppressed. In Group III, all 17 patients were aspirin-sensitive. PA parameters were similar to those in Group II (effective treatment). Clopidogrel significantly reduced ADP-induced PA only. Clopidogrel and cardiomagnil combination was the most effective option: ADP and adrenaline-induced PA was halved, compared to control parameters. Conclusion. In ACS syndrome patients without ST elevation, antiaggregant therapy control by platelet function monitoring provides an opportunity for choosing the most effective, individualized treatment. Comparative antiaggregant effectiveness was measured during fraxiparin therapy.

Aim. To assess physical training (PT) effect on NO-dependent vascular and autonomous tonus disturbances in male students with atherosclerosis risk factors (ARF) and endothelial dysfunction (ED), as well as to develop the optimal PT protocol. Material and methods. In 90 healthy males, aged under 25 years, with ARF and ED, PT sessions were held 3 times per week: 30 individuals were training for 1 month, 30 – for 2 months, and 30 – for 3 months. At baseline and after PT course, lipid profile, blood pressure, physical stress tolerance, double product at rest and in physical stress were measured. Cardiointervalography and brachial artery Doppler angiography were performed at rest, as well as in hyperemia and hyperventilation tests. Control groups I and II included 30 students each; the participants with or without ARF did not underwent any PT course. Results. Endothelial and autonomous dysfunction limited oxygen-transporting system and oxygen-recipient tissue functional potential, decreased energy-producing reserve and aerobic capacity in students with ARF and ED. Onemonth PT was not enough for ED normalization, and three-month PT demonstrated proatherogenic effects.  Conclusion. Two-month PT protocol for ED correction and ARF modification increased primary prevention effectiveness in young students from cardiovascular risk groups.

Aim. To assess effectiveness, safety, cognitive and emotional effects of amlodipine as monotherapy and in combination with thiazide diuretic in middle-aged women with mild to moderate arterial hypertension (AH). Material and methods. The study included 30 women aged 35-50 years with Stage I-II AH, receiving amlodipine monotherapy (2,5-5 mg/d, with dose titration to 10 mg/d), and in combination, if needed, with hypothiazide (25 mg/d). Cognitive function and emotional status were assessed by correcting test, number sorting test, Hospital Anxiety and Depression Scale (HADS), and Taylor anxiety scale. Results. In 96,4% of the patients, amlodipine therapy resulted in reaching target blood pressure (BP) levels, and monotherapy was effective in 67,8% of the cases. Amlodipine and hypothiazide combination was necessary for 28,6% of the patients. Treatment was associated with significant improvement in attention concentration parameters, decreased levels of anxiety and depression, as well as high treatment compliance and low adverse event rates. Conclusion. Amlodipine is effective for BP control, being also characterized by beneficial influence on psychoemotional status and by high treatment compliance.

Aim. Program OSCAR-2006 has been initiated with an aim to identify high-risk patients in real-world clinical practice settings. The article presents the results from the epidemiological part of the Program. Material and methods. OSCAR-2006 Study included 235 doctors from 36 Russian cities, and 7098 patients: 3673 males (51,8%), 3425 females (48,2%), aged 25-75 years, with myocardial infarction (MI) and/or myocardial revascularization, and/or stable angina, diabetes mellitus (DM), peripheral artery disease in anamnesis, and, therefore, high cardiovascular risk. Socio-demographic, anthropometric, clinical and some laboratory parameters were assessed. Results. More than 50% of males and 8,8% of females were current smokers. High blood pressure was diagnosed in 83,4%, dyslipidemia – in >70%, DM – in 20% of the patients examined. Therefore, 97,4% of the participants had at least one risk factor. Coronary heart disease (CHD) was diagnosed in almost 80%, mostly in males. Males had MI in anamnesis twice as often as females. By the study start, 6% of the patients had suffered stroke, and 20% had peripheral artery disease. As regards the treatment, 87,2% of the participants received antihypertensive therapy: about 60% - at least 3 antihypertensive medications, 10% - two medications, and only 8,7% were on monotherapy. Conclusion. Studies devoted to clinical practice analysis, problems of high-risk patient identification, adequate prevention and treatment in such individuals should be regarded as an important step towards population-level reduction of cardiovascular risk.

Phytosterols and phytostanols are plant analogs of cholesterol, inhibiting cholesterol (XCH) absorption by intestine epithelium and, therefore, decreasing CH blood levels. Sterols and especially stanols are absorbed in the intestine to a much lesser extent than CH, and their plasma concentrations are also less than those of CH. It is known that rare cases of hypercholesterolemia, e.g., genetic hypersitosterolemia, are linked to increased coronary heart disease risk. For stanols, there is no evidence of such a risk. Development of lipid-dissolving stanol esters provided an opportunity to enrich various foods (spreads, yogurts, milk, etc.; trade mark Benecol, Raisio Company, Finland) with physiological stanol ester doses (1,5-2,0 g/d). Stanol consumption results in CH and low-density lipoprotein CH level decrease by 10-15%, in addition to low-lipid diet effects, and therefore could be used for prevention and treatment of atherogenic hypercholesterolemia. 

A loop diuretic torasemide is characterized by high bioavailability and prolonged action, explaining some beneficial pharmacodynamic features of the medication. Demonstrating a clear antihypertensive effect, torasemide can be used as monotherapy or combined with other antihypertensives. Torasemide benefits, comparing to furosemide, in chronic heart failure treatment have been confirmed in numerous large-scale studies. Its pharmacokynetics remains virtually unchanged in patients with chronic liver or renal failure. Adverse effects are similar to those in other diuretics, by both quality and quantity. Therefore, torasemide can be used more widely in modern clinical practice.

The article is devoted to an important issue of anxiety states in general and cardiovascular practice. The author reviews diagnostics of the most prevalent anxiety disorders, as well as relevant modern therapeutic approaches in general practice.

The article is devoted to antiaggregant clopidogrel place in cardiovascular disease treatment. It contains modern views and recommendations by carious experts from most reputable international medical organizations

The article reviews the trials on the association between increased functional activity of platelets and platelet membrane polyunsaturated fatty acids (PUFA), PUFA in serum lipoprotein phospholipids, and dyslipoproteinemia (DLP) type and severity. Platelet structural and functional disturbances, often accompanying DLP and influenced by its type, affect platelet aggregation – via platelet membrane lipid modification, as well as via modified synthesis of platelet functional activity modulators (e.g., TxA2 ). Possible approaches to platelet hyperaggregation correction are discussed, including membrane lipid modulation via lipoprotein profile normalization during pharmaceutical and non-pharmaceutical treatment.

The review is devoted to modern views on hypertriglyceridemia (HTG) etiology and pathogenesis, and its casual role in some disease development. Data on normal TG metabolism, main causes of HTG, its clinical role and diagnostics are discussed. Even though HTG plays an important role in atherosclerosis, pancreatitis, Alzheimer disease, pre-eclampsia development, it is still inadequately described, from clinicians’ point of view.

Long-term controlled trials’ results provide a chance to assess individual complication risk. The review discusses prognostic value of ECG-controlled stress test parameters in patients with coronary heart disease (CHD) and stable angina. Various prognostic indices are presented, based on complex analysis of clinical and basic instrumental parameters, which assist in long-term prognosis assessment and adequate therapy choice in CHD patients.

The review is devoted to biological role of reactive oxygen forms, generated in various cells of all healthy organisms, and performing, due to their high chemical reactivity and short lifetime, vital function of signal intracellular transduction and intercellular mediation, realizing immediate and delayed adaptation of tissue metabolism, circulatory system included. In excessive amount of these molecules, their moderating function transforms into damaging oxidation and destruction of tissue lipids, proteins and nucleic acids. This concept is supported by numerous clinical data on substantial increase in tissue and plasma levels of active oxygen forms and oxidative cellular biopolymer damage products among patients with essential arterial hypertension, atheroscleroisis, coronary heart disease and myocardial infarction. The leading pathogenetic role is played by local and/or systemic hyperproduction of superoxide and hydroxide radicals, hydroperoxide, NO, peroxinitrite and other active oxygen forms.