In the issue.

Aim. To evaluate the real practice of thrombolytic therapy of patients with ST-elevation myocardial infarction (STEMI) at cardiological departments of Saratov and Saratov region hospitals.

Material and methods. Retrospective pharmacoepidemiologic study was carried out. Case histories of STEMI patients discharged from cardiologic departments of several central district hospitals (CDH) of Saratov region, cardiologic department of one of Saratov general municipal hospitals (MH) and urgent cardiology department of Saratov clinical hospital (CH) in 2006 were analyzed.

Results. In CH all patients received thrombolytic therapy given they did not have contraindications and were admitted to the hospital timely. Few patients received thrombolytic therapy in MH and CDH in 2006.

Conclusion. Correlation between hospital type and quality of STEMI management has been revealed.

Aim. To evaluate efficacy and safety of ramipril (Hartil, Egis) in treatment of patients with different cardiovascular risk (according to arterial hypertension (HT) risk stratification) in real clinical practice.

Material and methods. 998 patients (424 men and 574 women; aged 57,4±0,4 y.o.) with HT; with combination of HT and ischemic heart disease; with ischemic heart disease and high normal blood pressure (BP) were included in the open non-control non-comparative multicenter phase IV study. The anamnesis data collection, physical examination, evaluation of risk factors, the target organ damage, the associated cardiovascular diseases, total cardiovascular risk, previous therapy, and also BP measurement were performed. All patients received ramipril within 8 weeks additionally to previous antihypertensive therapy. The BP measurement was performed initially, after 4 and 8 weeks of therapy. Achievement of target BP level (BP<140/90 or <130/80 mm Hg in patients of high or very high cardiovascular risk) was used as efficacy criterion.

Results. 790 (82,1%) hypertensive patients used antihypertensive therapy before the study. 675 (85,4%) patients received ACE inhibitors, 435 (55%) patients - beta-blockers, 230 (29,1%) patients - calcium channel blockers, 420 (53,2%) patients – diuretics and 28 (3,5%) patients - angiotensin II receptor blockers. Ramipril additionally to previous therapy provided achievement of target BP in 69,4% of patients with high and in 64,8% of patients with very high cardiovascular risk.

Conclusion. Addition of a ramipril to the treatment of patients with high and very high cardiovascular risk increases efficacy of the therapy.

Aim. To compare the antihypertensive and metabolic effects of combined therapy (carvedilol reception and «School of the hypertensive patient») with these of the carvedilol monotherapy in young patients with arterial hypertension (HT) of 1-2 degrees with overweight and obesity.

Material and methods. 63 out-patients with HT of 1-2 degrees (aged 18-27 y.o.) with overweight and obesity were included in the open parallel randomized clinical preventive trail. Patients wеre randomized into 2 groups. All hypertensive patients received the carvedilol (Vedicardol, Sintez, Russia) 25 mg daily. Carvedilol dose was enlarged twice in case of insufficient antihypertensive effect. Patients of the main group (n=32) also passed through the special educational program «School for hypertensive patients». Changes in blood pressure (BP) level, body mass index, biochemical markers and risk factors were evaluated initially and in 24 weeks of therapy.

Results. Patients of the main group had more significant risk factor manifestations decrease than in group of comparison. More significant body mass index decrease was also observed in the main group in comparison with group of comparison: from 32,5±0,4 to 26,4±0,7 kg/m2 (p<0,01) and from 31,8±0,8 to 28,9±1,18 kg/m2 (p<0,05), respectively. In patients of the main group systolic and diastolic BP decreased by 20,1% and 25,6%, respectively, wile in patients of the group of comparison – by 18,9% and 26%, respectively.

Conclusion. It is reasonable to combine carvedilol therapy with special training in the young hypertensive patients with overweight and obesity.

Aim. To compare the antihypertensive and metabolic effects of combined therapy (carvedilol reception and «School of the hypertensive patient») with these of the carvedilol monotherapy in young patients with arterial hypertension (HT) of 1-2 degrees with overweight and obesity.

Material and methods. 63 out-patients with HT of 1-2 degrees (aged 18-27 y.o.) with overweight and obesity were included in the open parallel randomized clinical preventive trail. Patients wеre randomized into 2 groups. All hypertensive patients received the carvedilol (Vedicardol, Sintez, Russia) 25 mg daily. Carvedilol dose was enlarged twice in case of insufficient antihypertensive effect. Patients of the main group (n=32) also passed through the special educational program «School for hypertensive patients». Changes in blood pressure (BP) level, body mass index, biochemical markers and risk factors were evaluated initially and in 24 weeks of therapy.

Results. Patients of the main group had more significant risk factor manifestations decrease than in group of comparison. More significant body mass index decrease was also observed in the main group in comparison with group of comparison: from 32,5±0,4 to 26,4±0,7 kg/m2 (p<0,01) and from 31,8±0,8 to 28,9±1,18 kg/m2 (p<0,05), respectively. In patients of the main group systolic and diastolic BP decreased by 20,1% and 25,6%, respectively, wile in patients of the group of comparison – by 18,9% and 26%, respectively.

Conclusion. It is reasonable to combine carvedilol therapy with special training in the young hypertensive patients with overweight and obesity.

Aim. Comparative study of amiodarone and bisoprolol efficacy in patients with ventricular arrhythmia and metabolic syndrome.

Methods. 146 patients with the AHA/NHLBI 2005 metabolic syndrome and symptomatic ventricular arrhythmia were included in the study. 52 patients received regular oral amiodarone (200 mg daily, 5 days a week) therapy, 55 patients received bisoprolol (10 mg daily) treatment and 39 patients did not receive any antiarrhythmic therapy (control group). Treatment efficacy was evaluated by Holter monitoring (before start and after 1, 3, 6, 9, 12 months of therapy).

Results. Significant efficacy advantage of bisoprolol vs this of amiodarone was observed in 12 months of therapy (50.0% of effectively treated patients vs 17.3%, p=0.02). Significant difference in a number of patients ceased therapy because of antiarrhythmic effect loss was also revealed (20.0% vs 46.1%, p=0.004). A number of patients stopped therapy because of side effects was comparable in the both groups. Patient age younger than 42 years old in combination with a number of ventricular premature beats morphology less than 4 allowed predicting effective antiarrhythmic treatment for both drugs with sensitivity of 70.3% and specificity of 65.0%.

Conclusion. Bisoprolol have an advantage (versus amiodarone) within 9-12 month therapy in patients with ventricular premature beats and metabolic syndrome. Drug refractoriness and side effects monitoring is necessary.

Aim. To evaluate antihypertensive effects of new generic amlodipine (Stamlo M) in comparison with original amlodipine (Norvasc) in monotherapy and in combination with angiotensin converting enzyme (ACE) inhibitor and diuretic in patients with arterial hypertension (HT) of 1-2 degree.

Material and methods. 60 patients with HT of 1-2 degree were included in the open randomized parallel comparative study. Patients were split into 2 groups. Study duration was 10 weeks. Efficacy control, dose correction, addition of ACE inhibitor and diuretic was performed each 2 weeks.

Results. The significant antihypertensive effect of monotherapy was observed in both groups already by the 2-4 weeks of therapy. Significant differences between amlodipines in influence on blood pressure (BP) level and heart rate was not found. Monotherapy with generic amlodipine (10 mg OD) provided target BP level more than in half of patients. Achievement of target BP levels was found in 89% and 96% of patients treated with generic and original amlodipine, respectively, when they were combined with lisinopril (10 mg OD) and hydrochlorothiazide (12,5 mg OD).

Conclusion. New generic amlodipine (Stamlo M) is an effective and safe antihypertensive drug comparable with original amlodipine in clinical efficacy.

Aim. To evaluate risk of repeated atherothrombotic events in patients survived acute coronary syndrome (ACS) and having poorly reduced platelet aggregation (proven by optical aggregometry) in response to acetylsalicylic acid (ASA) therapy.

Material and methods. 200 patients with ACS (aged 56,6±9,2 y.o.) were included in the study. Platelet functional activity during ASA therapy was evaluated with laser aggregometer. ASA resistance was defined if the summarizing index of platelet aggregation (induced with ADP, 5 mμml/l) was 50% or higher during ASA therapy. Observation period was 18±6 months. Atherothrombotic events (unstable angina, myocardial infarction, stroke, cardiovascular death) were considered.

Results. Lack ASA response rate was about 12%. Totally 22 repeated atherothrombotic events were registered: 5,6% among ASA sensitive patients and 50% - among ASA resistant patients. Repeated atherothrombotic events were registered in ASA resistance patients during first 14 days. ASA sensitive patients showed repeated atherothrombotic events in some months after ACS. The relative risk of cardiovascular event in ASA resistance patients was 8,92 (CI 95% 4,39; 17,84 р=0,05).

Conclusion. The high level of the induced platelet aggregation (proven by laser aggregometry) points to high risk of repeated atherothrombotic events in patients with ACS.

International Diabetes Federation consensus, devoted to definition of the metabolic syndrome was published in 2006. The main statements of this document are presented and commented.

Results of combined therapy of gallstone disease (GSD), non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH) and hypercholesterolemia (HCE) with statins and ursodeoxycholic acid (UDCA) are analyzed. In GSD statin therapy was often accompanied with reduction of bile lithogenicity but did not always accelerate stone litholysis under their combination with UDCA. Statin induced liver injuries are often observed in NAFLD and NASH, adjuvant UDCA therapy shown positive effect on inflammatory and histological liver parameters in these diseases. Serum lipid levels in patients with HCE were reduced most effectively with statin combined with UDCA. Combined therapy with statin and UDCA is recommended in patient with HCE and chronic liver diseases.

Data of evidence based medicine which confirm efficacy of acetylsalicylic acid (ACA) in cardiologic practice are presented. The special attention is given to generic drugs of ACA. Their application has increased essentially recently. Some of generics are comparable with original drugs on clinical efficacy but have economic advantages.

Statin usage for primary and secondary prevention of cardiovascular diseases is focused. Rational choice between original and generic drugs is discussed taking into account efficacy and safety ratio.

Aim. To study influence of enalapril, digoxin, atenolol and diltiazem on lipid peroxidation and antioxidative protection in experimental disorders of glucose and lipid metabolism.

Material and methods. White nonlinear mice were used for modeling of the complex metabolic disorders by alloxan and cholesterol infusion. Evaluation of acute drug toxicity and indicators of lipid peroxidation and antioxidant protection was performed. Superoxide dismutase and catalase activity, malondialdehyde concentration were evaluated.

Results. Toxicity of digoxin, diltiazem, atenolol in complex metabolic disorders was increased, and toxicity of enalapril was unchanged. Enalapril had antioxidant effect. Atenolol had prooxidative effect in myocardium and kidneys, and diltiazem - in kidneys.

Conclusion. Enalapril showed antioxidant effect and decreased concentration of secondary products of lipid peroxidation in renal tissue. It may be considered as the first line drug in complex metabolic disorders.

Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation (ending).

European guidelines on management of acute myocardial infarction in patients presenting with persistent ST-segment elevation 2008. What changed? (comments to updated).

Results of the control randomized studies in 2009: what is new in cardiology.

To the jubilee of academician Leo Antonovich Bokeria: curing the hearts.

Press release: significant extend of possibilities for regional cardiologists – the main task of the second year National award in cardiology “Purple heart”.

Index of the articles published in the journal “Rational Pharmacotherapy in Cardiology” in 2009.