No 4 (2016)

The article presents the results of a targe study EMPA-REG OUTCOME dedicated to the assessment of the possible increase in patient survival by reducing the total and cardiovascular mortality against the background of use of empagliflozin. It is concluded that empagliflozin represents a fundamentally new class of drugs with innovative mechanism of action not related to the insulin effects or insulin secretion. Obviously, clear evidence of pronounced protective effects on kidneys and cardiovascular system, and the ability to reduce total and cardiovascular mortality after 3 months of therapy allow empagliflozin to occupy a special place in the algorithms for the management of patients with type 2 diabetes mellitus.

There is an urgent need to find effective pharmacological treatments to combat the growing obesity epidemic. Over the past 3 years it has been approved by a number of new drugs for weight loss. Most of them affect the way the formation of hypothalamic appetite through dopaminergic and serotonergic signals. Some of them are a combination therapy that allows the use of lower doses, reducing the possibility of side effects, but are less clear in terms of the long-term results. The most interesting approach, still, is to simulate the endogenous signals using satiety hormones suppressing appetite. Interesting, study of thermogenesis of brown adipose tissue in order to increase power consumption in chambers and more effective influence on the weight. Pharmacotherapy of obesity has already gone through several difficult stages, improved understanding of the pathways that regulate energy balance and possibilities of their correction. At the same time, lessons learned and new studies provide more confidence that the current approaches to the management of body weight at the same time are effective and safe.

Metformin is one of the most prescribed and effective anti-diabetic drugs in the world, which provides additional benefits for patients with type 2 diabetes for the control of certain risk factors for cardiovascular diseases, reduce cardiovascular morbidity and mortality, reduce the risk of some forms of cancer. There is increasing evidence of a variety of biological pleiotropic effects of metformin (antioxidative, hypolipidemic, anti-inflammatory, anorectic effect, anti-atherosclerotic, antiproliferative), the clinical significance of which requires further study.

Analysis of changes of indicators of daily monitoring of arterial pressure (DMAP) in 46 patients with acromegaly in the active phase is given. Systolic-diastolic arterial hypertension was registered in 2/3 of patients. In the analysis of their diurnal profile of blood pressure (BP) the insufficient reduction of BP during the night and cases of nocturnal hypertension were noticed. DMAP is advisable in all patients with acromegaly to register the presence of arterial hypertension, objectification of level of BP and its diurnal dynamics, selection and monitoring of antihypertensive therapy.

The modern conceptions of the role of free fatty acids (FFA) and glycolysis in the energy metabolism of the myocardium are considered. Experimental models of myocardial ischemia have shown that some medicines are capable of altering the metabolism in cardiomyocytes, transferring it from FFA oxidation to more efficient process - the oxidation of glucose and lactate. In coronary artery disease, cardiomyocyte metabolism may vary depending on the stage of chronic heart failure (CHF). Some changes are compensatory in nature, thereby they partially improve the impaired metabolism, while others may further depress processes of energy formation in the myocardium. Drugs that have the ability to influence metabolic processes in myocardium include cytoprotectors, antioxidants and antihypoxants. Trimetazidine and ranolazine fall into the first group; ubiquinone refers to the second group. Cytochrome C deserves special attention among antihypoxants. Results of clinical studies carried out in the cardiological practice have shown that this drug has a good clinical effect in patients with cardiovascular diseases, including CHF, significantly improves myocardial function in hypoxic conditions and allows optimizing the treatment of patients. Given the «universality» of the action of Cytochrome C and its safety, this drug can be used also in other diseases accompanied by hypoxia (diabetes mellitus, compromised liver function and cerebral circulation disorders).

Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of sudden cardiac death (SCD), especially in patients with frequent exacerbations for 5 years after diagnosis. The article provides an overview of the problem of SCD in patients with COPD. Into the risk group of developing SCD we include patients with COPD with a previous pathology of the cardiovascular system (myocardial infarction, hypertension, arrhythmias), patients with severe COPD, who have phenotypes "frequent exacerbations" of respiratory disease. One of the main reasons that may underlie the development of sudden death, is the development of cardiac arrhythmias that most often recorded in patients with COPD undergoing extensive myocardial infarction. The pathogenesis of arrhythmias in patients with COPD is multifactorial. Detection of comorbidity in patients with COPD will allow to take into account their individual characteristics when choosing pharmacotherapy. COPD patients with a high risk of SCD is necessary to limit the frequent use of bronchodilators, in particular short-acting methylxanthines, drugs that can prolong the interval QT (for example, 14-membered macrolides).

The article presents the analysis of the current literature regarding the new potentials for the use of moxonidine in hypertensive patients. Currently, moxonidine (Physiotens®) is the most frequently used sympatholytic, not only because of its pronounced effects on blood pressure, but due to additional metabolic effects. Several clinical studies have demonstrated high efficacy of moxonidine in prevention of development of insulin resistance and normalization of associated metabolic disorders. Organoprotective properties of moxonidine, in particular, cardio-, nephro-, and vasoprotective effects, are associated with a decrease in insulin resistance, decreased activity of the sympathetic-adrenal system. Particular attention is paid to the problem of vascular aging, telomere biology, insulin resistance, and calcium- phosphorus homeostasis. The possible ways to impact these processes, including the possible use of moxonidine, are consedered.