The article is devoted to the role of increased heart rate (HR) as cardiovascular disease predictor. Many epidemiological studies demonstrate the link between this parameter and total and cardiovascular mortality. The authors describe rhythm-decelerating therapy with a new medication – ivabradine, specifically affecting sinus node function. Pilot studies confirm its antianginal efficacy, pointing to its potential in stable coronary heart disease management.

Aim. Pulse wave velocity (PWV) is a classic index for arterial and aortal elasticity assessment. Aortal PWV is a strong independent predictor of cardiovascular mortality in patients with arterial hypertension (AH). The aim of the study was to investigate arterial elasticity in the elderly AH patients, as well as to assess the effectiveness, safety, and PWV effects of indapamide retard 1,5 mg (Arifon retard) in individuals aged over 80 years. Material and methods. The study included 89 patients aged over 65 years. Using vascular screening system VS-1000 VaSera, Fukuda Denshi, Japan, brachial-ankle PWV (PWVba), carotid-femoral PWV (PWVcf), cardioankle vascular index (CAVI), ankle-brachial index (ABI) were determined. Sixteen patients aged over 80 years, not treated with antihypertensive medications before, were administered Arifon retard (1,5 mg once per day) as 12-week monotherapy. At baseline and in the end of the follow-up period, PWV parameters were measured. Results. Maximal PWV and CAVI values were registered in patients aged over 80 years, comparing to younger participants. There were significant associations between PWVba and age (r=0,49), systolic blood pressure (BP) (r=0,54) and pulse BP (r=0,53), between PWVcf and systolic BP (r=0,62), pulse BP (r=0,66) and diastolic BP (r=- 0,48). There was no correlation between CAVI and BP. Arifon retard treatment associated with significant reduction of systolic and pulse BP, without orthostatic hypotension development, as well as with PWVba and PWVcf decrease. CAVI did not change significantly. Conclusion. In AH patients aged over 80 years, with decreased vascular elasticity, Arifon retard treatment resulted in well-tolerated reduction of systolic BP, pulse BP, and aortal PWV. CAVI was independent of BP level and did not change during the treatment.

Aim. To study vasomotor endothelial function (EF) in the elderly patients with arterial hypertension (AH), during its pharmaceutical correction. Material and methods. In total, 66 individuals aged over 60 years, with isolated systolic and systole-diastolic AH (ISAH, SDAH) were examined. All patients underwent 24-hour blood pressure monitoring (BMP), ultrasound assessment of EF and intima-media thickness (IMT), endotelin-1 level (ET-1) measurement, and lipid profile assessment. All participants received Nifecard® XL (Lek, Slovenia), for 6 months. Results. In ISAH patients, endothelial reaction to reactive hyperemia was significantly weaker than that in SDAH participants. AH patients had insufficient brachial artery vasodilatation in nitroglycerin test, as well as increased ET-1 levels. Maximal ET-1 levels were registered in SDAH individuals. After six-month Nifecard® ХL treatment, vascular EF substantially improved. According to 24-hour BPM data, BP circadian rhythm disturbances were quite common, being observed in 80% of ISAH patients, and 44.4% of SDAH subjects. During 6-month therapy, Nifecard® ХL demonstrated high antihypertensive activity: BP circadian rhythm normalized, number of patients with normal circadian rhythms doubled, and number of patients with unsatisfactory nighttime BP decrease, or nighttime AH, decreased. Conclusion: EF normalization and target BP level achievement are the main tasks of AH treatment. Long-acting, extended-release calcium antagonists are effective in the elderly patients.

The article contains main results of PROLOG study, that compared effectiveness of controlled arterial hypertension therapy in step-wise antihypertensive treatment scheme: ACE inhibitor, spirapril, with addiction, if necessary, of diuretic hydrochlorthiazide, and beta-adrenoblocker atenolol (intervention group), vs standard treatment, prescribed by out-patient clinic doctors (control group). The follow-up period lasted for one year. Throughout the study period, systolic and diastolic blood pressure levels were significantly lower in intervention group than in control one. Cardiovascular event risk reduction was more pronounced in intervention group: 33% vs 22% in control group. PROLOG study results coincide with data from other large-scale, randomized, controlled studies.

Aim. To compare microcirculation (MC) functional status during the treatment with beta-adrenoblockers (BAB), with and without vasodilatatory effects, in patients with Stage I-II arterial hypertension (AH). Material and methods. In total, 61 Stage I-II patients and 30 relatively healthy volunteers were examined. AH patients received nebivolol or metoprolol for 24 weeks. At baseline, and after 4, 12, and 24 weeks, MC hemodynamic types (MCHT) were assessed by laser Doppler flowmetry (LAKK-02 device, “LASMA”, Russia). Ключевые слова: артериальная гипертония, состояние микроциркуляции, гемодинамические типы микроциркуляции, β-адреноблокаторы, небиволол, метопролол. Results. AH is characterized by heterogeneous MC changes: hyperemic MCHT is typical for Stage I AH, and stasis-congestive or spastic MCHT – for Stage II AH. During metoprolol therapy, normocirculatory MCHT increased, and hyperemic MCHT decreased. Nebivolol demonstrated normalizing effects, manifesting in decreased hyperemic or spastic MCHT and increased normocirculatory MCHT. Conclusion. Metoprolol improved MC functional status. Nebivolol normalized functional and morphological MC status.

Aim. To study effectiveness, safety, and dynamics of cognitive function in eprosartan therapy among arterial hypertension (AH) patients after stroke (S) or transient ischemic attack (TIA), comparing to standard antihypertensive therapy. Material and methods. The study included 60 AH patients, who underwent S or TIA. All participants wee randomized to two equal groups. Mean age in Group I was 62,2±7,8 years, in Group II – 59,8±6,7 years; AH duration - 9,5±3,5 and 9,8±3,2 years, respectively. For 3 months, Group I received eprosartan (600 mg/d), as monotherapy or combined with hydrochlorthiazide, if target blood pressure (BP) level was not achieved. Group II received standard antihypertensive therapy. At 4 visits, BP, heart rate, body mass index were measured; medication tolerability were assessed. At the baseline and at the end of the study, electrocardiography, echocardiography, 24-hour BP monitoring (BPM), psychological testing with Beck and MMSE questionnaires were performed. Results. In 2 patients (6,7%) from control Group II, recurrent TIA episodes were registered. In both groups, a significant positive dynamics of all manually measured BP parameters was observed. At the end of the study, BP positive dynamics was more manifested in eprosartan group. Moreover, in Group I, depression and cognitive dysfunction levels substantially decreased. Conclusion. Eprosartan is an effective antihypertensive agent for AH treatment, with cerebroprotective effects in S and TIA patients, that could be used as monotherapy or in combination with a diuretic.

Aim. To compare effects of atorvastatin in the doses of 10 and 20 mg/d on lipid profile, C-reactive protein (hsCRP), fibrinogen levels, as well as vascular wall structure and function in patients with coronary heart disease (CHD) and primary hyperlipidemia (PHL). Material and methods. Fifty CHD and PHL patients were randomized to 10 or 20 mg/d atorvastatin doses (no titration), for 24-week period. Atorvastatin effects on lipids, treatment tolerability (symptoms ± increased hepatic enzymes), as well as on endothelial function, vessel elasticity and stiffness, were examined. Results. After 24 weeks of 10 mg/d atorvastatin treatment, levels of total cholesterol (TCH), triglycerides (TG), and low-density lipoprotein CH (LDL-CH) significantly decreased – by 25,4%, 21,7%, 34,9%, respectively. In 20 mg/d group, these figures were 27%, 15,2%, and 43,9%, respectively. No significant inter-group difference in LDL-CH levels was registered. No substantial CRP and fibrinogen level reduction was observed. During 24 weeks, 7 adverse events were registered, only 2 (4%) being related to atorvastatin therapy. Conclusion. In patients with CHD and PHL, atorvastatin (10-20 mg/d) decreased LDL-CH levels by 35-44%, and was well-tolerated. The therapy did not affect hsCRP and fibrinogen levels.

Aim. To study hypolipidemic effectiveness and safety of generic lovastatin (Cardiostatin®). Material and methods. This open, cooperative study included 90 patients with coronary heart disease (CHD) and hypercholesterolemia (<10 mmol/l). All patients received Cardiostatin® in the dose of 20 mg/d, increased up to 40-80 mg/d, if needed. Dynamics of total cholesterol (TCH), low-density lipoprotein CH (LDL-CH), high-density lipoprotein CH (HDL-CH), triglycerides, hepatic enzymes, and C-reactive protein (CRP) levels was studied. Results. Cardiostatin® improved lipid profile to the same extent as original lovastatin. Target TCH level (<2,5 mmol/l) was achieved in 68,8% of the patients. In participants with initially increased CRP level, it had significantly reduced. Conclusion. Cardiostatin® demonstrated good hypolipidemic effects, at the same time reducing increased CRP level. Cardiostatin can be recommended for dyslipidemia and atherosclerotic pathology treatment.

Aim. To study ACE inhibitor effectiveness and safety in heart failure-free patients with arterial hypertension (AH) and stable coronary heart disease (CHD). Material and methods. Society of Cardiology of the Russian Federation initiated the National Program PREMIERE, focused on ACE inhibitor perindopril (2/4/8 mg/d) effectiveness, safety, blood pressure (BP) and clinical effects in AH and CHD patients. The number of participants achieving target BP levels, as well as therapy tolerability, was assessed. The study involved 199 doctors from 14 Russian cities; 1997 patients with AH and/or CHD, and associated risk factors (RF). Mean age of the patients was 57 years, mean follow-up duration – 6 months. In total, 1920 patients (96,1%) completed study protocol. Results. Perindopril treatment was associated with BP reduction; 86% of the participants reached target BP levels, <140/90 mm Hg, by the end of the study. Perindopril therapy was equally effective in men and women, regardless of age, CHD and diabetes mellitus. The weekly number of angina attacks and ischemic ECG sign rates significantly decreased. Comparing to pre-treatment 6 months, during 6-month therapy period, significantly less hospitalization cases were registered. Adverse events were observed in 165 patients (9,8%); in 44 participants (2,2%), the medication was withdrawn. Conclusion. PREMIERE study provided promising data on perindopril clinical effectiveness and tolerability (8 mg/d) in patients with AH, CHD, and RF. This treatment scheme could be recommended for primary healthcare settings.

Aim. To study effects of various streptokinase thrombolytic therapy (TLT) and following antithrombotic therapy variants on coagulation hemostasis and fibrinolysis parameters; to prove the opportunity to use reduced streptokinase doses in acute myocardial infarction (AMI) treatment. Material and methods. In total, 56 AMI patients received standard streptokinase dose, 1 500 000 U; 61 patients received reduced streptokinase dose, 750 000 U. In each group, thrombolysis was followed by various antithrombotic regimens. In all participants, coagulation hemostasis and fibrinolysis parameters were measured before TLT, 3 hours, 5, 10, and 20 days later. Results. Reduced streptokinase dose influenced coagulation hemostasis and fibrinolysis parameters similar to standard dose. No benefits for any special post-thrombolysis antithrombotic therapy regimen were registered in AMI patients. Conclusion. In AMI patients, reduced streptokinase doses could be used for TLT. After TLT, aspirin monotherapy can be recommended.

The review is devoted to acetylsalicylic acid (ASC) use in cardiology. Recent epidemiologic surveys demonstrated the important role of thrombosis as a factor provoking exacerbation of coronary heart disease, ischemic stroke, peripheral artery disease. Therefore, antithrombotic and antiplatelet therapy becomes most important in treating these diseases and in secondary prevention of vascular occlusion. Numerous studies proved that ASC therapy (75-325 mg/d) decreases risk of myocardial infarction, stroke, and cardiovascular mortality by approximately 25%. The review also contains the results of most reliable ACS trials, and comparison of ACS therapy with other antiplatelet regimens. An emphasis is put on ASC therapy safety. A relatively new medication, Cardiomagnyl, is described – a combination of ASC and non-absorbing antacid, Mg hydrate. This combination minimizes the risk of gastro-intestinal complications, including hemorrhage and perforation.

Multiple population studies have demonstrated an inverse relationship between dietary content of ω3- polyunsaturated fatty acids (ω3-PUFA) and cardiovascular disease (CVD) risk. Increased consumption of ω3- PUFA, due to diet modification or supplement intake, was associated with decreased mortality in CVD patients. Clinical effectiveness of ω3-PUFA medication, Omacor®, was demonstrated in the largest, prospective trial on ω3-PUFA and prognosis in coronary heart disease (CHD) - GISSI-Prevenzione. In total, 11323 patients diagnosed with myocardial infarction (MI) in less then 3 previous months and receiving modern therapy, were randomized to 1 g/d of concentrated ω3-PUFA, or 300 mg/d of vitamin Е (α-tocopherol), or ω3-PUFA and vitamin E combination, or placebo (control group). Mean follow-up period lasted for 44±5,4 months. By the end of the study, only in participants receiving Omacor®, total mortality decreased by 21%, cardiovascular mortality – by 30%, and sudden death (SD) risk – by 44%, comparing to placebo group. Benefits of ω3-PUFA treatment manifested relatively early: total mortality decrease was statistically significant after 3 months, and after 4 months SD risk significantly reduced by 53%. ω3-PUFA demonstrated positive pleyotropic action, with post-IM SD rate decrease as the most important clinical effect.

The authors discuss statinotherapy perspectives for secondary prevention, emphasizing statins’ effectiveness due to their high hypolipidemic activity and multiple pleiotropic effects. Aim. To study hypolipidemic activity and safety of generic atorvastatin (Liptonorm®), in comparison to original atorvastatin, Liprimar®. Material and methods. Thirty patients with coronary heart disease (CHD) and hypercholesterolemia (HCH) were randomized to 12-week original or generic atorvastatin treatment. Blood lipids, hepatic enzymes, and kreatine phosphokinase levels were measured. Results. Total cholesterol (TCH) levels in Liptonorm® and Liprimar® groups reduced from 7,7±1,25 to 4,4±0,8 mmol/l and from 6,9±1,3 to 4,6±0,7 mmol/l, respectively; low-density lipoprotein CH levels reduced from 5,4±1,4 to 2,7±0,7 mmol/l and from 4,7±1,3 to 2,7±0,7 mmol/l, respectively; triglycerides’ levels reduced from 1,7±0,7 to 1,2±0,3 mmol/l and from 1,9±1,0 to 1,2±0,4 mmol/l, respectively. High-density lipoprotein CH levels increased from 1,03±0,25 to 1,13±0,21 mmol/l and from 1,32±0,31 to 1,37±0,28 mmol/l, respectively. Lipid profile dynamics throughout the study was significant and similar in both groups; enzyme levels remained virtually Conclusion. Atorvastatin generic Liptonorm® demonstrated blood lipid effects similar to those for original atorvastatin.

Reduction in total cholesterol (TCH) and low-density lipoprotein CH (LDL-CH) levels while taking food products enriched in plant stanol ethers (PSE) might be explained by inhibited intestine enterocyte CH absorption. PSE inhibit both food and biliary CH absorption. Unsaturated fatty acid-etherized stanols are well-soluble in high-fat foods (spreads), as well as in low-fat products (milk, kefir, yogurts, etc.). Serum TCH and LDL-CH levels are effectively reduced (by 7-10% and 12-15%, respectively) with PSE doses of 1,6-2,8 g/d. In hypercholesterolemia (HCH) patients receiving CH synthesis inhibitors – statins, PSE-enriched food intake associates with additional LDL-CH decrease by 10-20%. PSE-enriched “functional” products might be widely used for non-pharmaceutical HCH treatment and cardiovascular prevention on population level.

The article contains modern data on vasospastic angina ethiology and pathogenesis, discussing possible genetic and neuro-humoral factors. Rho-kinase role in coronary spasm mechanisms is emphasized. New pharmaceutical approaches to Prinzmetal angina treatment, as well as perspectives of its surgery correction, are reviewed.

More and more experimental and clinical data confirm that typically, arteriogenic form of erectile dysfunction (ED) is not a late complication of cardiovascular disease (CVD), but an early manifestation of systemic vascular pathology. One important mechanism, common for both ED and CVD, is endothelial dysfunction, affecting various vascular basins, including penis corpus cavernosus. The latter effect results in decreased synthesis and/or bioavailability of NO – the main erection mediator. Systemic character of vascular pathology in arteriogenic ED patients is confirmed by associated large artery endothelial dysfunction, and explains previously demonstrated increased risk of latent coronary heart disease in ED males. This emphasizes the importance of aggressive early ED diagnostics not only by urologists, but also cardiologists and therapeutists. ED presence points to the need for more detailed examination and early intervention.

According to modern views, the key component in atherosclerosis pathogenesis is endothelial dysfunction (ED), manifesting in dysbalance between main endothelial functions: vasodilatation and vasoconstriction, proliferation inhibition and promotion, antithrombotic and prothrombotic, antioxidant and prooxidant functions. Endothelial effects are mediated through vasoactive agents’ release – vasodilatators (NO, prostacyclin, bradykinin) and vasoconstrictors (endothelin, free oxygen radicals, thromboxan A2 , angiotensin II). It has been demonstrated that virtually all atherosclerosis risk factors (RF) realize their negative effects via ED. Therefore, endothelial function parameters could be used as early atherosclerosis markers in individuals with atherosclerosis RF, at pre-clinical stage. Pathogenetic therapy, administered early or in already verified atherosclerosis, could improve patients’ prognosis substantially.