Aim. To study the effects of the ramipril and amlodipine combination on blood pressure (BP) levels and anxiety and depression indices in patients with arterial hypertension (AH) and Type 2 diabetes mellitus (DM-2).

Material and methods. In total, 25 patients with AH and DM-2 were examined. All participants underwent 24-hour BP monitoring, psychological status assessment, and glycated haemoglobin level measurement at baseline and 6 months after the start of the combined therapy (ramipril 5-10 mg/d; amlodipine 2,5-10 mg/d).

Results. In 81,2% of the patients, depressive disorders were observed, with mild and severe depression in 45,7% and 3,2%, respectively. The levels of personal (52,3±3,4) and reactive anxiety (57,2±3,9) were elevated. By the baseline MMPI results, the participants were divided into two groups: Group I – with hyposthenic register, Group II – with sthenic register. Antihypertensive therapy (AHT) was associated with reduction in all scales of the neurotic triad in Group I, and with more homogeneous estimates across scales in Group II. Mean systolic and diastolic BP levels were significantly reduced by 18% and 13%, respectively, without any significant dynamics of heart rate (71,5±0,9 bpm at baseline, 72,3±0,8 bpm after 6 months). According to office BP measurements, BP normalisation (≤130/80 mm Hg) was observed in 81% (n=20).

Conclusion. In patients with AH and DM-2, anxiety and depressive disorders are widely prevalent, which should be considered when administering AHT. The combination of ramipril and amlodipine was effective in >80%, improving not only metabolic profile, but also clinico-psychological status of the patients.

Aim. To evaluate the effectiveness of magnesium orotate in the patients with cardiac arrhythmias, arterial  hypertension (AH), and idiopathic mitral valve prolapse (MVP). 

Material and methods. The complex examination, dynamic follow-up, and placebo-controlled differentiated  treatment were performed in 84 patients with idiopathic MVP. All participants underwent echocardiography,  24-hour blood pressure monitoring (BPM) and electrocardiography (ECG) monitoring, office BP measurement,  spectral analysis of heart rate variability (HRV), and physical stress test. The main group (MG; n=43) received  magnesium orotate (3000 mg/d) for 6 months; the comparison group (CG; n=41) received placebo. 

Results. According to the 24-hour ECG monitoring data, the treatment was associated with disappearance of  high-grade arrhythmias and a 40% reduction in supraventricular (paroxysmal and non-paroxysmal) tachycardia  incidence. The number of ventricular extrasystoles was reduced in 26%, and they disappeared in 54%. In 8%,  polytopic ventricular extrasystoles were substituted by occasional monotopic extrasystoles. These changes were not  observed in the CG patients. The percentage of Stage I AH patients decreased from 38% to 8% in the MG, and  from 30% to 20% in the CG. 

Conclusion. In MVP patients, magnesium orotate treatment improved electro-physiological heart parameters,  with reduced supraventricular and ventricular extrasystole incidence and improved circadian BP profile. 

Aim. To compare the pharmacokinetics and pharmacodynamics of verapamil retard, regularly taken by patients  with Stage I-II arterial hypertension (AH).

 Material and methods. The effects of the administration time (morning vs. evening) on verapamil retard pharmacokinetics were investigated. This open, randomised, cross-over study included 14 patients with Stage I-II AH,  who were regularly administered verapamil retard for 3 weeks. Before the active therapy started, all antihypertensive medications were withdrawn, with an exception of short-acting agents (“wash-out” period). Two weeks later,  the patients were administered verapamil retard, according to the randomisation scheme, and were recommended  to take one tablet in the morning or evening, at the same time every day. The first administration was at the clinic,  under medical supervision. Three weeks later, the participants were hospitalised for pharmacokinetics assessment. Seven days after the end of the first treatment course, a second course started, with an inverted time of verapamil retard administration. Blood concentration of non-modified verapamil was measured by high-performance liquid chromatography with fluorescent detection.

Results. Significant differences in pharmacokinetics were observed for morning vs. evening verapamil administration. The respective maximal verapamil concentrations were 239,7±152,3 vs. 148,6±107,4 ng/ml (p<0,01), and respective half-life times were 12,50±3,48 vs. 22,57±15,24 hours (p<0,05). For other parameters, the difference was non-significant.

Conclusion. In Stage I-II AH patients, the morning administration of Isoptin SR resulted in accelerated increase of its plasma concentration. At the same time, the evening administration was associated with increased half-life time and higher “concentration-effect” correlation, which makes the latter variant more rational.

Aim. To evaluate the pregnancy and delivery course, as well as fetal and newborn status, while achieving optimal blood  pressure (BP) levels with different regimens of antihypertensive therapy (AHT) in pregnant women with chronic arterial hypertension (AH). 

Material and methods. Starting from Trimester I, pregnant women received AHT, with dose titration and optimal BP  achievement. Group I received chronic beta-adrenoblocker therapy (BAB), Group II – was administered BAB in  Trimesters I and III, and calcium antagonists (CA) in Trimester II. Group III received CA in Trimesters I-III. The  control group (CG) did not receive any AHT. 

Results. Optimal BP levels were achieved more often in Group II. In Group III, inadequate BP control was linked to  early gestosis. In CG, systolic and diastolic BP levels (SBB, DBP) were significantly higher. DBP was normalized more  often than SBP. The minimal gestosis prevalence was observed in Group II (30%). Mean delivery terms in Group II were  the latest, with the best newborn status by Apgar score and the lowest prevalence of delivery complications. The CG  demonstrated the worst Apgar score parameters, due to hypoxia and ischemia of central nervous system in the newborns.  Group I was characterised by prevalent respiratory distress syndrome in the newborns. Higher BP levels were generally  associated with worse newborns’ functional status and lower mean body weight; however, in Group II, this association  was not observed. 

Conclusion. BP reduction to the optimal levels was safe and the most effective in rotation-based AHT (BAB+AC+BAB)  among pregnant women with chronic AH. 

 Aim. In patients with acute coronary syndrome (ACS), to detect pre-activated (primed) phagocytes in peripheral blood and  to evaluate the effects of trimetazidine MB, when added to standard therapy, on reactive oxygen species (ROS) production. 

Material and methods. In 113 hospitalised ACS patients – 86 with myocardial infraction (MI) and 27 with unstable angina  (UA) – the dynamics of blood leukocytes and ROS (baseline activity and PMA (phorbol-12-myristate-13-acetate) stimulated activity) was assessed by lucigen-dependent chemiluminescence method. In 60 participants, trimetazidine MB (70  mg/d) effects on ROS production were investigated. 

Results. At hospital admission, blood leukocyte levels, basal and PMA-stimulated ROS production were significantly  higher in AMI patients (especially in those who subsequently died) than in UA participants. Trimetazidine MB therapy  facilitated more rapid and manifested leukocyte count reduction, compared to the standard therapy alone: the respective  reductions at Days 3-5, 7-10, and 15-21 were -20 vs. -14%, -37 vs. -30%, and -47 vs. -32%. In the trimetazidine MB group,  the basal and PMA-stimulated ROS production did not change significantly, while in the standard therapy group, the ROS  production increased from Day 3 to Day 15.

Conclusion. Adding trimetazidine MB to standard therapy of ACS patients significantly reduced the peripheral blood leukocyte count at Days 15-21, without leukocyte activation in the sub-acute phase of myocardial ischemia. 

Aim. To study the safety, lipid-lowering effectiveness, and anti-inflammatory activity of three-month therapy with generic atorvastatin (Atomax) in patients with high cardiovascular risk and dyslipidemia (DLP).

Material and methods. The study included 36 DLP patients: Group I (n=17) with coronary heart disease (CHD) and normal carbohydrate metabolism, and Group II (n=19) with Type 2 diabetes mellitus (DM-2) and CHD in 52,6%. For one month, Atomax was administered in the dose of 10 mg/d; afterwards, the dose was increased up to 20 mg/d if target levels of low-density lipoprotein cholesterol (LDL-CH) were not achieved.

Results. The initial Atomax dose resulted in LDL-CH decrease by 33,8% in Group I and by 38,8% in Group II. For the mean dose of 14,1 mg/d, the respective percentages were 39,8% and 44,6%; three month later, they reached 23,3-30,3% and 20,6-24,1%, respectively. Increased concentration of high-density lipoprotein CH (HDL-CH) was observed in Group I only (+15,6%). Additionally, Atomax treatment was associated with decreased blood levels of C-reactive protein, tumor necrosis factor-alpha, interleukin 1-beta, and interleukin-6 (the latter decreased in DM-2 patients only).

Conclusion. Atomax demonstrated good tolerability, lipid-lowering, and anti-inflammatory effects. Increased HDL-CH levels were observed in diabetes-free participants only.

Aim. To study the effectiveness and safety of clopidogrel and acetylsalicylic acid (ASA) in coronary atherosclerosis (CA) patients after coronary artery bypass graft surgery (CABG). To investigate intracellular metabolic activity of platelets and its association with platelet aggregation.

Material and methods. In total, 94 45-72-year-old men with coronary heart disease (CHD) and initially increased platelet aggregation (PLA) were randomised into two groups, receiving clopidogrel (75 mg/d; n=44) or ASA (75–100 mg/d; n=50). The patients not responding to the two-week therapy were regarded as therapy-resistant.

Results. In CHD patients after CABG, ASA resistance developed in 24%. In contrast to ASA, clopidogrel action mechanisms are based on the inhibition of platelet energy metabolism, and increased substrate flow towards nonprotein synthesis in red blood cells. These features could explain the development of laboratory-diagnosed resistance for ASA, but not clopidogrel. End-point analysis demonstrated that clopidogrel is more effective than ASA in the prevention of acute coronary syndrome, de novo angina, and cardiovascular death during the two-year follow-up of the post-CABG patients.

Conclusion. Clopidogrel therapy was not associated with laboratory-diagnosed resistance, and was more effective in terms of acute coronary event prevention than ASA.

Aim. To assess the pregnancy course and perinatal outcomes in women with congenital heart valve disease (CHVD).

Material and methods. In total, 150 medical histories of pregnant women with corrected CHVD (CCHVD; n=61) and non-corrected CHVD (NCHVD; n=89) were retrospectively analysed. All women gave birth at the specialised maternity centre in Moscow and the perinatal centre in Khabarovsk.

Results. The features of CHVD in pregnant women reflected the population patterns and were represented by interventricular and interatrial septal defects, aortal coarctation, open arterial duct, pulmonary artery stenosis, and corrected “blue” heart valve disease. Approximately 20% of the women learnt about their disease during the current pregnancy. In most women, the pregnancy course was uncomplicated, but in 9,8% (n=6) of CCHVD and 14,8% (n=13) of NCHVD women, heart failure (HF) symptoms developed and progressed at Weeks 28-32, when the hemodynamic load on cardiovascular system is maximal. Hospitalization and adequate treatment of these patients improved their clinical status and prolonged the pregnancy up to physiological terms. Over 50% of the women had cesarean delivery, despite no evidence of cardiovascular decompensation.

Conclusion. The first delivery in most women with CCHVD and NCHVD took place at young age. Cardiovascular decompensation was registered at Weeks 28-32, when the hemodynamic load is maximal.

Aim. To study the effects of hormone replacement therapy (HRT) on metabolic profile, insulin resistance (IR), central and peripheral hemodynamics, endothelial function and antioxidant activity in postmenopausal women with metabolic syndrome (MS).

Material and methods. The study included 30 postmenopausal women with MS, receiving Angeliq medication (estradiol 1 mg, drospirenone 2 mg) for 6 months. At baseline and 6 months after the start of the treatment, fasting and two-hour postprandial levels of lipids, glucose, and insulin were measured. The other parameters included HOMA-IR index, body composition and visceral fat percentage, 24-hour blood pressure monitoring (BPM), echocardiography, microcirculation (MC) parameters, endothelial dysfunction and oxidative stress markers.

Results. Mean body mass index (BMI) decreased from 30,9 kg/m2 to 30,2 kg/m2 (р=0,068), while mean visceral fat percentage changed from 40,6% at baseline to 42,2% after 6 months (р=0,002). These changes were explained by natural menopause course, as well as progressing IR and menopausal MS. BP levels were effectively reduced, according to the 24-hour BPM data; all participants achieved target BP levels. Left ventricular (LV) myocardial mass index significantly decreased from 116,1 to 110,8 (р<0,0001); LV diastolic function had improved. The treatment was associated with the correction in pathological MC types; the maximal improvement was observed for spastic MC type. Superoxide dismutase activity increased by 5,0% (р=0,034), which points to antioxidant effects of the medication.

Conclusion. Angeliq therapy was effective and safe in female patients with high cardiovascular risk. No negative effects on metabolic profile or IR were observed. The therapy was associated with MC improvement and BP reduction. The medication demonstrated cardioprotective and antioxidant activity.

Aim. To study health-related quality of life (QoL), psychological status, and their associations with cardiovascular (CVD) risk factors (RFs) in education and science professionals, to specify the priorities of CVD prevention in organized collectives of intellectual workers.

Material and methods. This preventive examination of two organized collectives of education and research workers assessed psycho-emotional status and health-related QoL. The examination was performed as a part of extended dispanserisation programme and included questionnaire survey, using such scales as HADS (anxiety and depression assessment), Reeder scale (stress assessment), and SF-36 (QoL).

Results. The high prevalence of anxiety and depressive disorders pointed to increased CVD risk. Most traditional RFs positively correlated with depressive disorder severity. The two collectives examined were significantly different in terms of health-related QoL and some parameters of psycho-emotional stress. This could be partly explained by different workplace settings and social circumstances.

Conclusion. In intellectual workers, CVD prevention should start with psycho-emotional and QoL correction, which could also improve the compliance to traditional RF correction.

This article aims to focus the attention of various health professionals, in particular practitioners and decision  makers, on the problem of quality of statistical information on acute coronary heart disease (CHD) morbidity and  mortality in the Russian Federation (RF). The authors summarize relevant evidence from local and international  studies. The current system of national epidemiology statistics in the RF is analysed. Potential ways to improve the  data collection mechanisms for acute CHD are discussed. In particular, the international expert consensus on  acute CHD terminology and diagnostics in epidemiological and clinical studies is presented, which could harmonize relevant research if implemented locally. 

The article discusses the principles of calculating cardiovascular morbidity and prevalence indices in the Russian  Federation and USA. The factors influencing significant international differences and affecting the comparability  of cardiovascular statistics across countries, are examined. 

The review analyses the latest publications on coffee consumption and cardiovascular disease (CVD) risk, CVD  complications, CVD risk factor (RF) levels, and Type 2 diabetes mellitus (DM-2) complications. Coffee did not  increase the risk of CVD and CVD complications, did not affect CVD RF levels, and reduced the risk of DM-2  complications. These positive effects of coffee consumption are explained by its beneficial influence on carbohydrate and lipid metabolism, oxidative stress, inflammation, and endothelial function. 

The introduction of drug-eluting stents has been a major achievement of interventional cardiology. These stents  demonstrate good clinical effectiveness and safety profile. However, prevention of restenosis and late stent thrombosis remains an important problem. The potential of antithrombotic treatment (Aspirin, clopidogrel) and postintervention management in patients with drug-eluting and non-drug-eluting stents are discussed. 

This review presents the main principles of secondary prevention of coronary heart disease. The importance of both non-pharmaceutical (lifestyle risk factor correction) and pharmaceutical approaches to cardiovascular risk reduction is emphasized. The pharmaceutical treatment is based on the medications with proved effectiveness: statins and anti-aggregants for all patients, beta-adrenoblockers and ACE inhibitors if indicated.

Chronic heart failure (CHF) manifests in heart insufficiency and inadequate blood flow in various organs and tissues. One of the most important CHF symptoms is reduced physical stress (PS) tolerability, due to impaired central hemodynamics and various peripheral mechanisms. Physical training (PT) improves PS tolerability, quality of life and prognosis in CHF patients. While PT effectiveness in CHF has been proved, there are various approaches to PT methodology. In particular, two types of PT are used – PT with constant PS intensity and interval PT. This literature review summarizes the evidence on the mechanisms of PS tolerability in CHF and PT effects in these patients. PT methodology (start time after decompensation, length, and intensity) is also discussed.

Москва, 4–5 февраля 2010 года Информационное письмо