No 13 (2015)

The study was aimed to the evaluation of the structural and functional features of left ventricular remodeling and the development of chronic heart failure (CHF) in patients with myocardial infarction (MI) taking into account the mode of revascularization and adherence to therapy. At the hospital stage, all patients (n=101) were randomized to treatment groups according to a method of myocardial revascularization. Group 1 consisted of patients who underwent thrombolytic therapy (TLT), Group 2 - patients with percutaneous coronary intervention (PCI), the Group 3 - patients who did not undergo revascularization. At discharge from the hospital and 1 year after MI, the following examination was performed: echocardiography and Doppler echocardiography, a 6-minute walk test (6MWT), Rating Scale of Clinical State (RSCS), and evaluation of NT-proBNP levels. Adherence to the 5-component therapy (statins, two antiplatelets, renin-angiotensin-aldosterone system blockers, β-blockers) during the 1 year was assessed using Morisky-Green questionnaire. According to the results of study after one year of observation, it was revealed that PCI contributed to the improvement of the clinical manifestation, increased exercise tolerance, and had significant positive influence on echocardiography indicators, regardless of adherence to therapy. TLT therapy in acute myocardial infarction, with adherence to therapy, prevented further progression of CHF. In patients without myocardial reperfusion, signs of abnormal maladaptive left ventricular remodeling and higher NT-proBNP levels were revealed, indicating the progression of heart failure, particularly in patients without adherence to therapy.

Article is dedicated to the review of studies on the relationship of endothelial nitric oxide synthase gene polymorphisms with the development of cardiovascular diseases. It is shown that the endothelial nitric oxide synthase gene encodes enzyme responsible for the synthesis of nitric oxide, which plays a major role in the processes of vasodilation. Suppression or reduction of the gene activity leads to the development of various diseases associated with endothelial dysfunction. Population-based data on the prevalence of the gene and its polymorphisms in the Japanese, Australian, Korean populations, and North European population are presented. It is concluded that insufficient information on the gene polymorphisms requires further research on this subject.

The study examined the associated risks of progression of periodontitis, the development of systemic inflammatory response and cardiovascular diseases. Additional pathogenetic link, reinforcing the relationship between the severity of periodontal inflammatory changes and the development of cardiovascular disease, includes systemic inflammatory response with increased high-sensitivity C-reactive protein (hs-CRP) and IL-6 levels in the blood. Associated course of somatic and dental pathology requires joint efforts of dentists and cardiologists to modify the common risk factors.

The article presents the results of the evaluation of pharmacoeconomic efficacy of free and fixed-dose combinations of antihypertensive drugs used in hypertensive patients with high and very high risk. Results of the study showed that treatment regimen using a fixed combination Ekvator had the greatest economic efficiency according with different criteria for hypotensive action.

The main target of anti-anginal and anti-ischemic therapy in patients with stable coronary artery disease (CAD) is the elimination of clinical symptom - angina pectoris. However, assessment of the effectiveness of such treatment should be performed taking into account variants of clinical manifestations of stable coronary artery disease course. According to European guidelines 2013, the arsenal of the practitioner includes two groups of drugs for the antianginal therapy. The first group consists of β-blockers, nondihydropyridine and dihydropyridine calcium antagonists. The second group includes nitrates, ivabradine, ranolazine and nicorandil, and trimetazidine. The use of combinations of recommended antianginal drugs allows to significantly increase the effectiveness of treatment of patients with coronary artery disease and their quality of life.

The article discusses the current state of the issue of blood viscosity at the most common cardiovascular diseases - arterial hypertension, atherosclerosis, coronary artery disease, and metabolic syndrome. The basic rheological parameters of blood affecting its fluidity - deformability and aggregation of red blood cells, hematocrit, platelet aggregation, fibrinogen, protein fractions, and lipids - are described. The role of blood and plasma viscosity in predicting mortality and cardiovascular risk is discussed. Particular attention is paid to the influence of drugs used in cardiology - statins, β-blockers, calcium channel blockers, nitrates, ACE inhibitors, diuretics - on the blood viscosity.

In recent years, the number of visits of patients with back pain and neck pain in health care institutions increased significantly. In most cases, back pain is caused by nonspecific degenerative changes in musculoskeletal system (spondylarthritis, osteoarthritis, osteochondrosis). Fundamentally new class of drugs for the treatment of pain syndromes, including back pain, is selective neuronal potassium channel openers - SNEPCO. One of representatives of this class of drugs is flupirtine (Nolodatak) - non-opioid analgesic that has antispastic effect on striated muscles.

The article lists the main approaches to the management of patients with migraine. Special attention is given to the treatment of migraine attacks. Classes of drugs with proven effectiveness in aborting migraine attacks are reviewed. The mechanism of action and the basic principles of the use of triptans, including sumatriptan - one of the most affordable and effective drugs in this class, are discussed.