[Practical guidelines for the diagnosis and treatment of transthyretin amyloid cardiomyopathy (ATTR-CM or transthyretin cardiac amyloidosis)].

This paper summarizes the data from updated international protocols and guidelines for diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM). The invasive and non-invasive diagnosis techniques and their combinations are briefly reviewed; the evidentiary foundations for each diagnostic option and tool are analyzed. The paper describes a customized algorithm for sequential diagnosis and differential diagnosis of patients with suspected ATTR-CM with allowance for the combination of clinical signs and diagnostic findings. Along with the awareness of primary care providers about the red flags of the disease and visualization criteria, as well as providing information to the patients about the possibility of performing therapy of ATTR amyloidosis and the risks of delayed diagnosis, the proposed algorithm enables timely patient routing and prescribing specific treatment.

[Cerebrovascular disease in patients with type 2 diabetes mellitus]. / Tserebrovaskulyarnye zabolevaniya u patsientov s sakharnym diabetom 2-go tipa.

The article discusses the current trends in the spread of carbohydrate disorders, discusses in more detail the problem of type 2 diabetes mellitus and associated cerebrovascular diseases. The spectrum of the therapeutic effect of the drugs neurox and neupilept is considered in relation to this category of patients.

[The use of drug based on technologically processed antibodies to endocannabinoid receptor type 1 in the treatment of obesity in adults: results of a multicenter double blind placebo controlled randomized clinical trial].

AIM: To evaluate the clinical efficacy and safety of Dietressa at a dose of 6 tablets per day for 24 weeks in the treatment of patients with Class 1 obesity. To compare the clinical efficacy of two treatment regimens (1 tablet 6 times per day and 2 tablets 3 times per day) for 24 weeks in the treatment of patients with Class 1 obesity. MATERIALS AND METHODS: A clinical trial included 493 patients with Class 1 obesity from 18 to 65 years. The proportion of patients who lose greater than or equal to 5 percent of baseline body weight, an average decrease of body weight, a change in waist circumference, dynamics of the quality of life, and the safety of the therapy were assessed. RESULTS: A weight decrease was established among patients without regard to the studied regimens of Dietressa (in a daily dose of 6 tablets with a six- or three-time intake). The goals were achieved by 49% [53%] of patients in the first treatment regimen (statistically significant compared to placebo therapy: p=0.04) [р=0.018]), 48% (51%) in the second (p=0.004 [р=0.0004]) and 48% [52%] of patients in the combined Dietressa group (p=0.0007 [р0.0001]). The average absolute weight loss was -4.44.2 [-4.84.2] kg in the Dietressa-1 group (p=0.0001 [р0.0001]) and -4.44.4 [-4.74.4] kg in the Dietressa-2 group (p0.0001) [р0.0001]). Against the background of the conducted therapy mental component was improved on week 4 (p0.0001) and 24 (p=0.006) as well as parameter of physical health on week 4 (p=0,003) and 12 (p=0,006). Waist circumference significantly decreased every 4 weeks in patients receiving Dietressa (p0.0001 for three comparisons between weeks). A 6-month course of Dietressa therapy demonstrated a favorable safety profile. The frequency of adverse events had no significant differences between Dietressa and Placebo groups. CONCLUSION: The monotherapy with Dietressa is safe, and it leads to at least 5 percent reduction in body weight during 24 weeks of therapy in patients with Class 1 obesity.

[Comorbid pathology of the cardiovascular system in young patients with relapsing-remitting multiple sclerosis]. / Komorbidnaia patologiia serdechno-sosudistoi sistemy u molodykh patsientov s remittiruiushchim techeniem rasseiannogo skleroza.

AIM: To study the state of the cardiovascular system and peripheral microcirculation in young patients with relapsing-remitting multiple sclerosis (MS). MATERIAL AND METHODS: The study included 45 MS patients (17 men and 28 women, age 28 [24; 32] years, disease duration 5.5 [2; 7] years). The control group included healthy controls (age 30 [25; 33] years). Neurological and cardiologic examinations included 24-hour Holter ECG monitoring and 24-hour blood pressure monitoring with determination of the daily arterial vascular stiffness, echocardiography, laser doppler flowmetry followed by an occlusive test to assess the state of microvasculation, levels of serum vascular cellular adhesion molecule-1 (VCAM-1). RESULTS: In MS group, the results of 24-hour blood pressure monitoring showed that the variability of systolic blood pressure and diastolic blood pressure during daytime hours was reduced compared to the control group (p<0.026 and p<0.002, respectively). The indicators of daily arterial stiffness in MS group were significantly increased (p<0.001). According to the results of Holter ECG monitoring, no heart rhythm disorder was detected in both groups, except an increase in the number of supraventricular extrasystoles in MS patients compared to the control group (p<0.005). There were no between group differences in echocardiography indicators. The level of VCAM-1 was significantly increased in MS group compared to controls (p<0.001). CONCLUSION: Young MS patients are at risk of cardiovascular diseases associated with the variability of blood pressure and indexes of daily arterial vascular stiffness.

[Prognostic significance of clinical-anthropometric, biochemical, metabolic, vascular-inflammatory and molecular-genetic markers in the development of the first ischemic stroke]. / Prognosticheskaia znachimost' kliniko-antropometricheskikh, biokhimicheskikh, metabolicheskikh, sosudisto-vospalitel'nykh i molekuliarno-geneticheskikh markerov v razvitii pervogo ishemicheskogo insul'ta.

AIM: To study the relationship between clinical-anthropometric, biochemical, metabolic, vascular-inflammatory, molecular-genetic parameters and the development of the first ischemic stroke, and to develop a prognostic model for determining the probability of its occurrence. MATERIAL AND METHODS: The study included 196 first ischemic stroke patients and 119 healthy people matched for age, place of residence and nationality to the group of patients. The main anthropometric, clinical, biochemical, metabolic parameters and markers of vascular inflammation and endothelial dysfunction were assessed. Single nucleotide polymorphisms of IL8, ADIPOQ, ADIROR, APOB, APOC-IV, BDNF, GRM3 genes were genotyped. RESULTS: Weight, BMI, waist circumference, homocysteine, insulin, adiponectin, cystatin C, ApoA1, Apo B, CHOL, HDL, LDL, TG, CRB-sh, glucose, uric acid, IL-1b, IL-4, IL-6, IL-8, TNF-a, VEGF-A were significantly associated with the first ischemic stroke. CONCLUSION: Based on the data obtained in this study, a probability model for the development of the first ischemic stroke was obtained. Of all the parameters studied, diabetes mellitus, adiponectin, Apo A1, IL-4 made the largest contribution to the probability of the first ischemic stroke.

[Pleiotropic Effects of Rosuvastatin in Chronic Obstructive Pulmonary Disease Patients With High Cardiovascular Risk].

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the list of common causes of mortality after cardiovascular diseases. The processes of atherogenesis and cardiovascular diseases are accelerated in patients with COPD. The key mechanisms of COPD pathogenesis are oxidative stress, depletion of antioxidant protection, development of the pulmonary and systemic inflammation and the development of endothelial dysfunction. This article discusses the pleiotropic effects of statins in patients with COPD.

[Pleiotropic Effects of Rosuvastatin in Patients With High Cardiovascular Risk].

hronic obstructive pulmonary disease (COPD) is the third leading cause of death in the list of common causes of mortality after cardiovascular diseases. The processes of atherogenesis and cardiovascular diseases are accelerated in patients with COPD. The key mechanisms of COPD pathogenesis are oxidative stress, depletion of antioxidant protection, development of the pulmonary and systemic inflammation and the development of endothelial dysfunction. This article discusses the pleiotropic effects of statins in patients with COPD.

[Modern tactics antihypertensive therapy: a place of Angiotensin converting enzyme inhibitors].

In a review article we presents an analysis of the new recommendations of the European Society of hypertension (ESH) and the European Society of Cardiology (ESC) on the management of arterial hypertension (2013). Main attention is paid to the tactics of antihypertensive therapy and the choice of drugs in the treatment of early hypertension. Target blood pressure levels in are discussed the historical aspect. Criteria for applicftion of monotherapy in the treatment patients with hypertension, and possible mechanisms for selection of antihypertensive drug are also discussed.

[What is the optimal choice of antihypertensive therapy based on: the class-specific effects or special properties of a drug?].

The review article presents data on the significance of activation of different components of the renin-angiotensin-aldosterone system (RAAS) in metabolic disorder progression and organ damage processes. Based on the analysis of the pharmacological properties of drugs and clinical evidence, the authors discuss the problems of the choice of RAAS blockers. The mechanisms of drug action on metabolic processes, atherogenesis, and vascular damage are discussed.

[Classification of the forms of hypertensive retinopathy on the basis of estimation of the bioelectrical retinal potential and contrast sensitivity].

The paper gives the results of electroretinographic and psychophysical studies in hypertensive patients with first-, second-, and third-degree blood pressure (BP) elevation. The most characteristic functional symptoms of hypertensive retinopathy were defined at different stages of its development. There may be impaired retinal bioelectrical activity and diminished contrast and color sensitivity both in the presence and absence of ophthalmoscopically visible changes. Based on the findings, the authors have developed a functional classification of hypertensive retinopathy in relation to the degree of BP elevation.

[Effects of nebivolol on microcirculation, platelet aggregation and blood viscosity in patients with essential hypertension]. / Vliianie nebivolola na mikrotsirkuliatsiiu, agregatsiiu trombotsitov i reologiiu krovi u bol'nykh arterial'noi gipertoniei.

AIM: To assess effects of a selective beta1-adrenoreceptor blocker acting in part via nitric oxide nebivolol on microcirculation, platelet aggregation and blood viscosity. MATERIAL: Thirty patients with mild-to-moderate essential hypertension (mean age 54,1-/+9,3 years). METHODS: Ambulatory blood pressure monitoring, laser doppler flowmetry, registration of spontaneous and ADP-induced platelet aggregation. Nebivolol (5 mg/day) or its combination with hydrochlorothiazide (12,5 mg/day) were given for 3 months. RESULTS: Treatment with nebivolol caused significant reduction of systolic and diastolic blood pressures. Spontaneous and low dose ADP-induced platelet aggregation significantly decreased during treatment while blood viscosity did not change. In patients with hyperemic and spastic-hyperemic hemodynamic type of microcirculation improvement of microcirculation occurred due to changes of myogenic tone of arterioles and precapillary sphincters and 'damping' properties of resistance arterioles. CONCLUSION: In patients with essential hypertension hypotensive action of nebivolol was associated with antiaggregation effect and improvement of blood flow in microvascular networks.

[Prognostic criteria of the efficacy of magnetic and magnetic-laser therapy in patients with the initial stages of hypertension]. / Prognosticheskie kriterii éffektivnosti magnitnoi i magnitolazernoi terapii u bol'nykh s nachal'nymi stadiiami gipertonicheskoi bolezni.

Study of the efficacy of a course of exposures to travelling pulsed magnetic field and magnetic laser sessions in 97 patients with stages I-II essential hypertension showed a high efficacy of travelling pulsed magnetic field in patients with hyperkinetic hemodynamics and initially just slightly shifted blood rheology and platelet hemostasis. Magnetic laser therapy is more effective in patients with eukinetic and hypokinetic hemodynamics and initially sharply expressed disorders of blood rheology and platelet hemostasis.

[The therapeutic correction of disorders in thrombocyte-vascular hemostasis and of changes in the rheological properties of the blood in patients with arterial hypertension]. / Lechebnaia korrektsiia narushenii trombotsitarno-sosudistogo gemostaza i izmenenii reologicheskikh svoistv krovi u bol'nykh arterial'noi gipertoniei.

158 patients with essential hypertension received beta-adrenoblockers and were exposed to travelling impulse magnetic field, magnetolaser radiation. The study of platelet-vessel hemostasis and blood rheology revealed a relation of good clinical response and increased exercise tolerance with initial platelet dysfunction and rheological disorders which underwent positive changes in the course of treatment.