卷 10, 编号 9 (2024)

Timely diagnosis of pre-diabetes (early carbohydrate metabolism disorders) and prevention of progression of this condition to diabetes mellitus (DM) are vital, especially for patients with cardiovascular diseases and their complications.

The aim: to determine the proportion of patients with impaired glucose tolerance (IGT, pre-diabetes) in a cohort of patients who suffered an acute cerebrovascular accident (ACVA), as well as the diagnostic peculiarities of this condition at different stages of observation and the frequency of metformin prescription for the prevention of type 2 diabetes mellitus.

Material and methods. In the frames of the register of patients who suffered an ACVA in 2012–2017, case histories and discharge summaries after the reference ACVA (n = 900), as well as outpatient cards of patients (n = 684) were analyzed. At in-hospital and outpatient stages of observation, that was completed in 2022, the number of patients diagnosed with IGT, frequency of metformin prescription to these patients, and achievement of the primary endpoint (total mortality) were determined.

Results. IGT diagnosis (according to the anamnesis data) was present in 81 (9.0%) of 900 hospitalized patients, in 87 (9.8%) of 684 discharged patients (according to the discharge summary data), in 63 persons (9.2%) diagnosis of IGT was confirmed at the outpatient observation stage. Due to discrepancy in the established diagnoses of IGT and diabetes mellitus at different stages of observation the overdiagnosis of these conditions during inpatient treatment was found. Metformin treatment was recommended only for 3.2% of patients with IGT. Higher mortality was characteristic of patients with diabetes mellitus comparatively to the groups of patients without glycemic disorders and with IGT, and only at the hospital observation stage (p < 0.05).

Conclusion. The frequency of IGT in the studied cohort averaged 9%. Significant discrepancies in establishing IGT diagnosis at hospital and outpatient stages of observation were revealed. Frequency of metformin prescription (a drug with a reliable evidence base for the prevention of diabetes) to patients with IGT at the outpatient stage was very low (3.2%).

Providing the quality and efficacy of drug therapy for patients during the 1st year after myocardial infarction (MI) leads to reduced risk of cardiovascular complications (CVC) and increased quality of life (QOL) for them.

The aim: to estimate the quality of therapy in patients after MI in terms of achieving target performance indicators during the 1st year.

Material and methods. PROFILE-MI prospective register included patients discharged from the hospital after MI event. Observation period was 1 year, visits were made every 2 months, the criterion for the efficacy of therapy was achieving target blood pressure (BP < 130/80 mm Hg), heart rate (HR 60–70 beats per minute at rest), and lipid spectrum parameters (low-density lipoprotein cholesterol, LDL < 1.8 mmol/l). A visual analogue scale was used to assess the life quality (QOL).

Results. The study involved 160 individuals: 106 male (66.2%) and 54 female patients (33.8%), aged 74.2 ± 11.2 years [33; 87]. Maximum daily doses of the main groups of drugs were not achieved in the treatment of these patients. At the 1st visit, only 46.9% of participants had target BP values, after a year of observation – in 34.7% (p = 0.001). Target HR values at the 1st visit were fixed in 31.9% of patients, after a year of observation – in 53.7%, (p < 0.001). Target total cholesterol values at the 1st visit were fixed in 11.8% of patients, after a year – in 41.4% (p < 0.001). The frequency of LDL determination did not exceed 30%. The average daily dose of statins was 20 mg for all drugs in this group. Life quality (QOL) indexes did not exceed 7 points on average (according to a 10-point scale).

Conclusion. According to the PROFILE-IM registry data, in real clinical practice, when treating patients after MI, the potential for therapy aimed at reducing CVC and increasing QOL is not fully realized. Patients were prescribed medium or low doses of drugs, which led to unsatisfactory indexes of achieving blood pressure, heart rate and lipid spectrum parameters, as well as to low level of QOL.

Estimation of the effect of percutaneous coronary intervention (PCI) on cardiovascular remodeling and the choice of optimal pharmacotherapy for cardiovascular prognosis improving are the cases of interest.

The aim: to evaluate the effect of a fixed combination of perindopril and amlodipine in a dose of 5/5 mg/day in addition to lipid-lowering and antiplatelet therapy at cardiac and vascular remodeling, as well as at clinical outcomes in patients with stable coronary artery disease who underwent PCI.

Material and methods. 108 patients (68 male and 40 female persons) aged 47–69 years (mean age 54.3 ± 5.8 years) who underwent primary PCI with stenting were examined. Patients were randomized into 2 groups – control (n = 40) and main (n = 68). Depending on the initial blood pressure (BP) levels, the participants in the main group were additionally divided into 2 subgroups: 40 individuals with stage I arterial hypertension (AH) and 28 without it. The patients were prescribed antiplatelet drugs and statins; in the main group, a combined drug of perindopril and amlodipine in a dose of 5/5 mg/day was additionally used. All participants underwent echocardiography and Doppler examination of the brachial and carotid arteries before and 12 months after primary PCI performing.

Results. Repeated studies 12 months after PCI showed more significant morphofunctional changes in the heart and vascular wall in the main group, especially in patients with baseline hypertension. Thus, the left ventricular (LV) myocardial mass index decreased by an average of 11.8% (p = 0.011), the LV ejection fraction increased by 10.3% (p = 0.017), and the cardiac index by 12.7% (p = 0.012). In the main group, more significant were the dynamics of transmitral diastolic flow and vascular wall parameters. Thus, in patients with baseline hypertension, the intima-media complex value decreased by an average of 15.6% (p = 0.007), and the endothelium-dependent vasodilation index increased by 30.9% (p <0.001).

Conclusion. It has been shown that the use of a combination drug of perindopril and amlodipine at a dose of 5/5 mg/day in patients who underwent PCI, regardless of the dynamics of blood pressure, causes reverse remodeling of the heart and vascular wall and thereby improves cardiovascular prognosis.

Multiple sclerosis (MS) is the most common demyelinating disease, one of the main neurological causes of persistent disability in young people. It is known that lipid peroxidation processes and endothelial dysfunction underlie the pathogenesis of not only cardiovascular diseases (CVD), but also MS. Information is also presented that CVD increases the probability of exacerbations and the frequency of hospitalizations in patients with MS.

The aim: to estimate the structural and functional state of vascular wall in patients with remittent clinical course of MS.

Material and methods. 45 patients with remittent MS aged 28 [24; 32] years, with a disease duration of 5.5 [2; 7] years, were examined. Control group consisted of practically healthy individuals aged 30 [25; 33] years. MS patients were examined neurologically with an assessment of disability using the Expanded Disability Disease Score. Daily blood pressure monitoring with daily vascular wall stiffness assessment, estimation of intima-media thickness (IMT) of the left and right common carotid artery (CCA), clinical and biochemical blood tests with lipid profile and glycemia determination were performed. In addition, the study participants were examined for oxidative stress and antioxidant protection, levels of endothelial dysfunction markers and systemic inflammation.

Results. In patients with MS, a significant increase in the average aortic pulse wave velocity, maximum and average IMT of the posterior wall of the left CCA, maximum IMCT of the posterior wall of the right CCA, as well as a significant increase in the level of C-reactive protein, oxidative stress indexes, and antioxidant protection were detected.

Conclusion. In patients with MS, markers of vascular wall damage were fixed in the form of increased endothelial stiffness and dysfunction; it was associated with an imbalance in the oxidant-antioxidant system, which can potentially contribute to the acceleration of the process of atherogenesis.

Article presents an estimation of cardiometabolic risk in residents of high mountains and lowlands of Kabardino-Balkarian Republic (KBR).

The aim: to determine the prevalence of risk factors (RFs) for cardiometabolic complications in residents of the highlands and lowlands of KBR using bioimpedansometry, computer photoplethysmography and volumetric sphygmography.

Material and methods. On the basis of the University clinic of Kh.M. Berbekov Kabardino-Balkarian State University 102 patients from Kabardino-Balkarian Republic aged 35–74 years were examined. The patients were divided into 2 groups: 1st group included residents of flat areas (51 persons: 16 males, 35 females, average age 60.59 ± 10.41 years), 2nd group – residents of mountainous areas (51 persons: 21 males, 30 females, mean age 62.09 ± 11.01 years). All study participants underwent noninvasive bioimpedance measurements, computer photoplethysmography, and volumetric sphygmography.

Results. In the observation groups, 7–9 modifiable risk factors for chronic non-infectious diseases were identified. Using bioimpedansometry, in participants a high prevalence of obesity, mainly of the 1st degree, was found. In both groups, the abdominal type of obesity predominated, which is more associated with the risk of diabetes mellitus developing. Also in both groups there was an increase in blood glucose levels, characterizing the impaired carbohydrate tolerance. The level of visceral fat was significantly higher in residents of flat areas.

Conclusion. Relatively healthy patients were diagnosed with stage 1 obesity, stage I chronic kidney disease, and impaired carbohydrate tolerance. They were recommended to have a diet therapy (standard diet No. 9 for 3 months), taking into account adequate caloric intake in terms of basal metabolic rate, increased physical activity, and prescribed fixed combinations of antihypertensive drugs and statins with a follow-up visit after 3 months and 1 year. A prospective analysis of the results based on compliance with these recommendations is planned. It was concluded that it is necessary to implement bioimpedansometry and methods for assessing arterial stiffness and endothelial function in the health survey of certain groups of the adult population.

Current article highlights the results of the main clinical studies in the field of dyslipidemia. Basing on them, remaining problems and unsolved issues are identified.

The aim of the review is to analyze a set of the main modern studies in the field of dyslipidemia, assess their application points, efficacy and tolerability of various lipid-lowering medicinal remedies, including innovative drugs. From considered drugs, plozasiran, olezarsen and obicetrapib led to a decrease of low-density lipoprotein (LDL) levels and an increase of high-density lipoproteins, at the same time demonstrating a favorable safety profile. Lerodalcibep significantly reduced LDL levels, achieving target level in 90% of patients. In turn, solbinsiran effectively reduced the levels of angiopoietin-like protein 3, triglycerides, low-density cholesterol and apolipoprotein B in a dose-dependent way with good tolerability. Despite the fairly wide range of lipid-lowering drugs already available on the pharmaceutical market, there remains a need to expand and continue studies on the treatment of dyslipidemias.

Bronchial asthma (BA) is a chronic inflammatory disease of the respiratory tract with various phenotypes. Phenotype associated with a severe, difficult-to-control course of the disease is BA with fixed respiratory obstruction (FRO). The high risk of exacerbations, difficulty in achieving control and the severity of asthma in such kind of patients are occurring due to damage of the peripheral airways. In this regard, the main therapeutic target for this disease is the distal parts of bronchial tree, and the efficacy of inhalation therapy depends on the degree of drug deposition in them. Extrafine fixed combination of beclomethasone dipropionate, formoterol and glycopyrronium bromide affects inflammation in the distal bronchial tree and is of priority in the treatment of patients with severe bronchial asthma and FRO helping to achieve disease control.

Coronary heart disease (СHD) is a significant problem of modern medicine. Even with the increasing of the frequency of revascularization among patients with such type of disease, the necessity for antianginal therapy prescription remains to be high enough. According to clinical guidelines, two lines of drugs are indicated for the treatment of exertional angina. First-line drugs have anti-ischemic effect due to vasodilation or slowing of the heart rate, i.e. their efficacy is limited by the functional reserves of the myocardium during ischemia. The aim of the represented clinical analysis is to demonstrate the possibilities of a personalized approach to the management of exertional angina patients. Addition of prolonged-release trimetazidine in a single dose of 70 mg (Deprenorm^® OD) 1 time per day to the ongoing antianginal therapy led to increase of the antianginal effect and improvement of life quality of the observed patient. A single dose of this medicine increases patient compliance with therapy, which allows us to consider its use as an optimal therapeutic option for СHD treatment.

Systemic lupus erythematosus is a systemic autoimmune disease of unknown etiology that develops in genetically predisposed patients under the influence of numerous external factors. A clinical case of systemic lupus erythematosus in 31-year-old male patient with the development of splenomegaly, lymphadenopathy, and lupus nephritis is described in the article. At the outpatient stage, the clinical picture was represented by periodic fever and articular syndrome in the form of polyarthralgia and volatile arthritis. Introduced case was particular because of the need to exclude lymphoproliferative disease in a patient with significant immunological indexes (ANF HEp2, ANA screen, ENA-screen, antibodies to dsDNA, C3, C4) due to severe lymphadenopathy. Diagnosis of lymphoproliferative disease was excluded after lymph node biopsy.

As the life expectancy of the world’s population increases, the medical and biological aspects of aging of both the body as a whole and individual organs are becoming increasingly important. The aim of the review is to summarize the literature data on numerous mechanisms and factors of liver aging at various levels of organization of living systems. The first part of the review contains information concerning molecular-genetic, cellular, and tissue changes that occur in liver during its natural aging.

Article considers the key issues of management of patients with early carbohydrate metabolism disorders at the primary outpatient healthcare level. The most important tasks at this stage of medical care include increasing the detection of prediabetes during preventive medical examinations and health surveys, active recommendations to patients on lifestyle modification, as well as timely prescription of pharmacotherapy. Drugs used in this case should affect various pathological mechanisms of the development of carbohydrate metabolism disorders, helping to control insulin resistance, glycemia, prevent the transformation of prediabetes into type 2 diabetes mellitus and prevent complications.

In the absence of a unified theory of general pathology, its creation depends on the clarification and systemic analysis of information concerning the general patterns of the occurrence, development and disappearance of the disease. The main aim of current work is to try to combine a number of ideological conceptions of disease and pathology, life and health. Practical significance of creating a unified theory of general pathology, and on its basis - the theory of disease evolution, is in the possibility of transferring preventive medicine to the category of pathology management systems, using the integration of the main aspects of the theories of the systems of control and prognostication.