Aim. To study influence of simvastatin application on clinic, the laboratory and tool data, and as the remote forecast at patients with ischemic heart disease of senile age (75 years and are more senior) with clinic of chronic heart failure.
Material and methods. . 60 men were included in research and women in the age of from 75 till 85 years, hearts suffering by ischemic illness with display of intimate insufficiency and divided on 2 equal groups a method of random numbers. Ill control group received standard therapy concerning ischemic heart disease and chronic heart failure, and ill groups of research, in addition to standard therapy, received simvastatin in a doze 20 mg / days. The period of supervision - 12 months.
Results. On the termination of the period of supervision there was an authentic divergence of curves survivals in observably groups for the benefit of the patients accepting simvastatin; authentic improvement of function vascular endothelium, reduction of a class of a stenocardia in group of intervention is marked. Clinical results are confirmed with decrease of level СRP, TNFá. Authentic growth of level NO of plasma in group of simvastatin application was not observed, and this fact in the given research contacts additional reception or a cancellation of prolonged nitrates patients during treatment.
Сonclusion. By results of the executed research positive influence simvastatin on clinic and the forecast of outcome of disease at patients of the senile age, suffering is confirmed with ischemic illness of heart. Significant growth of the by-effects limiting application simvastatin in a daily doze of 20 mg at patients to the given age group, is not marked. Research will be continued.

Aim. To assess the dynamics of vascular endothelial growth factor (VEGF), transforming growth factor-beta (TGF- 1) and VEGF receptor Flt-1 (sFlt-1 or sVEGF-R1) levels in coronary heart disease (CHD) patients before and after myocardial revascularization.
Material and methods: We examined fasting serum VEGF, TGF-β1 and sVEGF-R1 concentrations in 40 CHD patients (main group) 1 day before and 6 days after successful myocardial revascularization (percutaneous coronary intervention, PCI – 75%; grafting bypass surgery – 25%). Control group included 30 healthy volunteers, with fasting blood samples taken once.
Results: Serum levels of VEGF and TGF-β1 in controls were 166,9±96,9 and 120±32,4 pg/ml, respectively. Before myocardial revascularization in CHD patients, VEGF level was 192,4±166,1 pg/ml, and TGF-β1 level was 11±4,9 pg/ml. There was no significant difference in basic serum levels of VEGF (p=0,4), but TGF-β1 levels were significantly lower in CHD patients, comparing to controls (р<0,0001). sVEGF-R1 levels were very low in main (0,3 pg/ml) and control (0,2 pg/ml) groups (р>0,05). After myocardial revascularization, the levels of VEGF, TGF-β1 and sVEGF-R1 were 264,7±226,6, 11,7±4,9, and 0,2 pg/ml, respectively. There was a significant increase in VEGF levels (р=0,066), without any substantial changes in TGF-β1 (р>0,05) and sVEGF-R1 (р>0,05) levels 6 days after revascularization. VEGF level reduction was observed in 6 out of 30 (20%) patients after PCI and in 2 out of 10 (20%) patients after grafting bypass surgery. In the other cases, post5revascularization VEGF level
increased significantly, due to intra-revascularization transient myocardial ischemia.
Conclusion: Myocardial ischemia increased VEGF levels and decreased TGF-β1 levels, not affecting sVEGF-R1 concentration.

Aim. To assess the role of platelet (PL) and red blood cell (RBC) function changes in RBC-PL aggregate (RPA) formation among coronary heart disease (CHD) patients.
Material and methods. The study included 22 CHD patients (mean age 57±7 years) and 14 healthy volunteers (mean age 48±3 years). PL and RBC aggregation, RBC resistance were assessed with laser aggregation analyzer BIOLA. Circulating RPA counting and their morphological assessment were performed by scanning electromicroscopy. Mean PL volume (MPLV) was assessed by thrombocrit measurement.
Results. In CHD patients, spontaneous PL aggregation was higher than in controls (1,6±0,4 vs 1,1±0,3 U; p<0,05). MPLV in patients and controls was 11,8±1,4 and 8,6±1,3, respectively. For circulating RBC, 4,1±0,6% were included into RPA, with RB/PL ratio of 1:1-4. No RPA were observed in volunteers' blood. RBC aggregation was significantly higher in CHD participants than in controls (3,3±0,7 vs 1,4±0,2 U), and RBC resistance was lower, manifested in early hemolysis. Decreased RBC resistance resulted in ADP release and PL activation.
Conclusion. In CHD patients, RPA formation was associated with PL activation and spontaneous aggregation. Increased PL and RBC aggregation, combined with RPA formation, resulted in rheological disturbances in CHD individuals.

Aim. To assess carvedilol effectiveness in patients with coronary heart disease (CHD) and arterial hypertension (AH), with or without associated diabetes mellitus (DM).
Material and methods. The study included 27 participants with mild to moderate AH and effort angina of various functional classes. Thirteen patients also had DM in anamnesis. Carvedilol was administered in initial dose of 6,25-12,5 mg/d. At baseline and in the end of the study, clinical status, blood biochemistry, and 24-hour ECG monitoring data were analyzed.
Results. In patients with or without DM, regular carvedilol therapy facilitated significant decrease in heart rate, blood pressure, microalbuminuria, frequency and duration of pain and silent ischemia episodes with various rhythm disturbances. Carvedilol therapy was not associated with substantial metabolic disturbances.
Conclusion. Carvedilol was effective in complex CHD and AH treatment among DM patients.

Aim. To study patients’ awareness on arterial hypertension (AH), its treatment and prevention, as well as to investigate AH therapy compliance, the GARANT Study (PharmacoepidemioloGy of ARteriAl HyperteNsion in Real-World Ambulatory PracTice) was performed, supported by KRKA company.
Material and methods. Doctors and patients from 99 clinics in 63 Russian cities participated in the study. In total, 9214 patients (3189 men, 6025 women; mean age 54,7 years) responded to this doctor-performed survey.
Results. AH awareness was high enough, with as many as 86,8% of the patients knowing their blood pressure (BP) level. At the same time, only every third participant knew his or her cholesterol (CH) level. More than 70% of men and 80% of women knew that AH is a risk factor (RF). From the patients’ point of view, AH was the leading RF. Awareness on the other RF was below 33%, with only two exceptions: alcohol (42,2% for men, 35,8% for women) and smoking (38,4% and 30,9%, respectively).
Conclusion. While doctors are fully responsible for high BP diagnostics and explanation of pharmaceutical and non-pharmaceutical therapy benefits and risks to their patients, treatment compliance and lifestyle modification should be supported by patients themselves, their families, and society as a whole.

Aim. To access arterial hypertension (AH) prevalence, pathogenesis, and effectiveness of fixed-dose perindopril and indapamide combination in tuberculosis (TB) patients.
Material and methods. In total, 489 case records of patients with TB of various localization were analyzed; 42 patients with TB and AH were examined. Dynamics of 24-hour blood pressure monitoring (BPM) parameters, left ventricular (LV) morphology and function (echocardiography data), vegetative effects on hemodynamics (heart rate variability), and endothelial function (von Willebrand factor level measurement, reactive hyperemia test) were investigated.
Results. The rates of AH and TB combination were quite high. These patients were characterized by “non-dipper” and “night-peaker” 24-hour BMP profiles, hypersympathicotonia, LV remodeling, right heart hypertrophy tendency, and endothelial dysfunction. Twelve-week therapy with fixed-dose combination of perindopril (4,0 mg) and indapamide (1,25 mg) was associated with positive dynamics of pathogenetic disturbances in AH and TB patients.
Conclusion. AH and TB combination negatively affects cardiovascular system. Treatment with perindopril and indapamide combination provides antihypertensive effect and normalizes main mechanisms of BP regulation.

Aim. To study time domain parameters of heart rate variability (HRV) in bronchial asthma (BA) patients during BA exacerbation, complicated by respiratory failure and sympathomimetic overdose.
Material and methods. In total, 72 patients with persistent BA were examined: 41 men, 31 women; mean age 39,3±10 years; mean BA duration – 8,6±8,5 years. Patients with moderate and severe BA forms were prevalent: 36,1% and 42,7%, respectively. Seventy participants (97%) received β-agonists. Patients with moderate or severe BA received inhaled glucocorticosteroids (500-1500 mkg/d). In all participants, 24-hour Holter electrocardiography monitoring was performed, with time domain HRV parameters analysis (SDNN, SDANN, rMSSD, pNN50).
Results. In mild BA patients, SDNN was 116±12,1 ms, SDANN – 107±20,6 ms, rMSSD – 38,3±7,1 ms, pNN50 12±3,6%, and SDNNindx – 56±10 ms. In moderate and severe BA individuals, these parameters were significantly lower (p=0,002). There was a statistically significant inverse correlation between BA severity and SDNN (r=–0,59, p=0,03), or pNN50 (r=–0,32, p=0,004). Moreover, there was a statistically significant inverse correlation between β-agonist overdose and the following HRV parameters: pNN50 (r=–0,4; p=0,04), SDNN (r=–0,33; p=0,002), and rMSSD (r=–0,29; p=0,001).
Conclusion. BA duration and sympathomimetic overdose result in adrenergic dysbalance, segmental and suprasegmental autonomous activity disturbances, reduced HRV and increased arrhythmia risk.

Aim. To analyze intra-pair correlation of lipid-transport system parameters in fasting state and after food lipid load (FLL) in monozygotic twins (MT) with different body mass (BM), for identifying genetic and environmental factor role in atherogenic dyslipidemia development.
Material and methods. Nine pairs (n=18) of male and female MT aged 37-65 years were divided into two groups, by abdominal obesity (AO) presence (n=9) or absence (n=6). Three persons with gluteo-femoral obesity were excluded from the analysis. In all patients, standard FLL test was performed, with measurement of TCH, TG, HDL-CH, LDL-CH, apoAI, apoB, and their ratio, HDL components (CH, phospholipids, CH esters), and CH-acceptor HDL potential 3 and 6 hours after FLL test.
Results. In MT with or without AO, lipid and apoprotein LP parameters, as well as CH-acceptor HDL potential, were similar to those in previously examined large groups of patients with various obesity types. In MT with AO, small particles were more prevalent in sub-fraction HDL specter than in MT with normal BM. In MT, atherogenic LP parameters correlated with one another, including TCH, apoB, АТ (apoB/AI), LDL particle size in fasting state and after FLL. No correlation for fasting antiatherogenic HDL components was observed in MT. After FLL, HDL level and content, according to cell culture CH-acceptor HDL potential, began to correlate.
Conclusion. Lipid and apoprotein atherogenic LDL parameters in fasting state and after FLL were determined mostly by genetic factors. Levels and content of antiatherogenic HDL are mostly determined by environmental factors; their post-FLL dynamics is genetically determined.

Aim. To study clinical course and severe complication development in patients with severe hypertriglyceridemia (HTG), >10 mmol/l.
Material and methods. The study included 75 patients aged 21-68 years (mean age 49±11,05 years), examined at the Cardiology Complex in 1982-2006, with verified fasting HTG >10 mmol/l.
Results. Coronary heart disease (CHD) was observed in 45,2% of the participants (50% males, 37% females), arterial hypertension (AH) – in 68% (60,4% and 81,4%), Type 2 diabetes mellitus – in 42,6% (44,4% and 41,7%), pancreatitis – in 34,9% (33,3% and 37,5%, respectively).
Conclusion. In patients with severe HTG, high rates of CHD, AH, metabolic syndrome and pancreatitis were observed. Therefore, to prevent severe complications in such patients, detailed examination and adequate TH and cholesterol level control are necessary.

Aim. To assess long-term (6 months) Allicor therapy effects on lipid profile, lipid peroxidation (LP), and functional platelet (PL) activity in patients with moderate hypercholesterolemia (HCH).
Material and methods. The study included 56 patients with clinically manifested atherosclerosis and 56 patients with at least one risk factor (RF), but with no clinical atherosclerosis manifestation. In both groups, the participants were randomized (28 subjects in every sub-group) to Allicor therapy (300 mg/d) or lipid-lowering diet. After three months of Allicor therapy, in patients with clinically manifested atherosclerosis, the dose was increased up to 600 mg/d. Blood lipid profile, as well as the levels of lipoprotein (a), lp (a), plasma LP products, functional PL activity after adrenaline, ADP, ristocetin, and serotonin stimulation were measured.
Results. In both groups, long-term Allicor therapy significantly reduced atherogenic lipid profile changes, LP intensity, and initially enhanced PL activation, increasing PL platelet anti-aggregation, in contrast to diet group. Six-months Allicor therapy did not affect lp (a) levels.
Conclusion. Long-term (at least 6 months) Allicor therapy could be recommended as primary and secondary cardiovascular prevention method, normalizing aggregant and anti-aggregant PL activity, as well as lipid metabolism, in patients with moderate HCH.

Aim. To investigate the link between insulin resistance (IR) and lipid transport system in patients with fasting normoglycemia.
Material and methods. In 39 patients aged 2070 years, with fasting normoglycemia, the levels of lipids, apolipoproteins (apo), and IR parameters (insulin sensitivity index; ISI McAuley, HOMA-IR) were measured.
Results. In patients with fasting normoglycemia and low ISI McAuley, atherogenic dyslipoproteinemia was observed: increased triglycerides, apo B, apo B/apo AI levels, reduced low-density lipoprotein particle size; disturbed high-density lipoprotein (HDL)-mediated cholesterol (CH) transport: reduced levels of free and esterified HDL-CH, phospholipids, apo A1, decreased HDL-CH particle loading, increased apo AII/apo AI concentration ratio.
Conclusion. In patients with fasting normoglycemia, diagnosing latent carbohydrate metabolism disturbances, which are associated with lipid transport system abnormalities and potentially increased risk of coronary heart disease or Type 2 diabetes mellitus, provides an opportunity for early metabolic correction.

Aim. To assess effectiveness, safety, and tolerability of simvastatin (Vasilip) in patients with IIa and IIb dyslipidemia, as well as with hepatic disease.
Material and methods. The analysis included 30 patients receiving Vasilip (20 mg/d). At baseline and after 3, 6, and 14 months of the treatment, fasting levels of total cholesterol (TCH), triglycerides (TG), high-density lipoprotein CH (HDL-CH), low-density lipoprotein CH (LDL-CH), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activity, bilirubin and creatinine were measured. Vasilip lipid-lowering effectiveness and tolerability was assessed during 12 months of the therapy.
Results. After 12 months of Vasilip therapy, there was a significant reduction in TCH (17,5%), TG (26,3%), and LDL-CH (27,8%) levels; HDL-CH increase (23,3%) was not statistically significant. Atherogenicity index decreased by 36,7%. Vasilip therapy was well tolerated by individuals with hepatic pathology throughout the whole study. No significant increase in AST and ALT activity, glucose, creatinine or bilirubin levels was observed.
Conclusion. Long-term (one-year) simvastatin therapy (20 mg/d) in patients with lipid hepatosis was both safe and clinically effective.

Aim. To study the Russian atorvastatin generic (Liptonorm) effects on lipid metabolism in patients with coronary heart disease (CHD), essential arterial hypertension (EAH), and high risk of cardiovascular complications (CVC).
Material and methods. In total, 30 patients (17 men, 13 women; mean age 52,37 years) with CHD (n=21), EAH (n=9), and high CVC risk were examined. Plasma levels of total cholesterol (TCH) were >5,2 mmol/l, low‑density lipoprotein CH, LDL‑CH ‑ >3,0 mmol/l. Lipid metabolism parameters and transaminase levels were measured at baseline, as well as after 2 and 4 weeks of Liptonorm treatment (10 mg/d).
Results. After 4 weeks of the therapy, TCH and LDL‑CH levels were significantly reduced, by 22% from the baseline. Triglycerides (TG) concentration decreased to a lesser extent (8,8%); high‑density lipoprotein CH (HDL‑CH) and transaminase levels remained the same.
Conclusion. Four‑week therapy with the Russian medication Liptonorm (10 mg/d) significantly reduced TCH, LDL‑CH levels, decreased TG concentration, without affecting HDL‑CH level. Liptonorm was safe, well tolerated, without any serious adverse effects. Patients ioetns regarded Lipronotm therapy regimen as “convenient”, that might increase their therapy compliance. Moreover, 90% of the patients regarded the medication price as “adequate” for their income levels.

Aim. To study safety and effectiveness of autologic bone marrow mononuclears (BMM) transplantation in acute myocardial infarction (AMI) patients.
Material and methods. This open, randomized, controlled study included 44 AMI patients: 22 in intervention group (I) and 22 in control group (II). AMI-related coronary artery (AMI-CA) recanalization was performed by stenting. At Day 7-21 of AMI, 100 millions of autologic BMM were infused into AMI-CA in Group I. BMM distribution was studied by radionuclide 99mТс-HMPAO indication method. Clinical status, physical stress tolerance, quality of life were assessed; echocardiography, 24-hour electrocardiography monitoring, myocardial perfusion scintigraphy with 199Tl and ATP were performed. Plasma levels of fatty acid-binding protein, tumor necrosis factor)alpha (TNF)alpha), interleukin 1-beta (IL-1beta), insulin-like growth factor (ILGF), and basic fibroblast growth factor (FGF) were measured.
Results. Intracoronary BMM infusion resulted in myocardial BMM fixation. There was no inter-group difference in volume parameters and left ventricular (LV) ejection fraction. In intervention group, local LV contractility improved earlier. Transient perfusion defect remained at 6 months in control group only. In Group I, at Days 1 and 5, the levels of IL-1-beta and TNF-alpha were significantly lower, and ILGF-1 - significantly higher than in controls. BMM quantity directly correlated with basic FGF levels.
Conclusion. Cell cardiomyoplastics facilitates myocardial cell fixation, without damaging myocardium, triggering malignant arrhythmias or affecting global LV contractility, reduces IL-1-beta and TNF-alpha levels, increases ILGF-1 and basic FGF concentration.

Aim. To prospectively assess dynamics, stability, and prognostic value of blood lipid profile (LP) in adolescents, for identifying early coronary heart disease prevention approaches.
Material and methods. This prospective study included 347 boys and 332 girls. During 22-year follow-up, six clinical examinations were performed (at the age of 13-14, 15-16, 19-20, 21-22, 26 and 34-35 years). Examination program included measuring levels of total cholesterol (TCH), high-density lipoprotein CH (HDL-CH), and triglycerides (TG), body weight (BW) and height (BH), subscapular, abdominal, and triceps skin fold thickness (SST, AST, and TST), pubescence assessment.
Results. Gender differences in LP, especially in pubescence, could not be completely explained. Increased LP atherogenity and dyslipidemia (DLP) rates in young males were associated with increased BW and fat tissue percentage. Mildly increased and normal TCH, HDL-CH, low-density lipoprotein CH (LDL-CH) in pubescent boys and girls were equally stable and not associated with increased risk of atherogenic DLP in adult age. In pubescent adolescents, TCH predicted its level in 34-35 year-olds only in combination with physical development parameters. Overweight in pubescent boys was an independent predictor of future hypercholesterolemia in adult age.
Conclusion.The observed age LP dynamics points to the need for early preventive measures in risk groups and general population, starting in pre-pubertal or early pubertal periods.

The article contains present and possible promising methods for improving prognosis in coronary heart disease (CHD) patients after coronary bypass surgery (CBS). Increasing CBS rates in Russia requires active implementation of methods improving short and long-term prognosis. Bypass stenosis mechanisms involve chemokine system. Secondary CHD prevention includes risk factor control, anti-aggregant, beta-adrenoblocker, lipid-lowering, and ACE inhibitor therapy. Recent studies have demonstrated beneficial w-3 polyunsaturated fatty acid role in improving surgery outcomes and prognosis in CHD patients.

ACE inhibitors are widely used in the treatment of arterial hypertension, chronic heart failure, and other cardiovascular pathology. The article is devoted to ACE pharmacology and their optimal use in clinical practice.

Coronary restenosis remains the main problem for effectiveness of percutaneous transluminal coronary angioplasty (PCA) and coronary stenting (CS). The aim of this review is to analyze pathogenetic mechanisms of coronary restenosis after PCA and CS, as well as various polymorphisms of relevant candidate genes as potential genetic markers of post‑PCA and post‑CS restenosis.
Both pathophysiological mechanisms and genetic basis are different for stent restenosis and post‑PCA, stent‑free restenosis. There are genes, which could be used as genetic markers of stent restenosis risk. For PCA restenosis risk, there are genes, also used as genetic markers. Genetic testing before percutaneous coronary interventions could identify patients with high restenosis risk, that, combined with new pharmaceutical approaches, will decrease coronary restenosis rates after PCA and CS.