[PECULIARITIES OF DIAGNOSTICS AND TREATMENT OF PATIENTS WITH RECURRENT MYOCARDIAL INFARCTION].

The aim of the study was to evaluate the efficiency of invasive strategies for the treatment of 306 patients with recurrent myocardial infarction (IM) admitted to our clinic in 2003-2007. We compared the results of three approaches: various forms of transdermal coronary interventions (TDI) including delayed (24-72 hr) ones (n = 30), surgical myocardial revascularization within 8-12 weeks after the onset of recurrent myocardial infarction (n = 25), and conservative therapy (n = 251). Overall cardiovascular lethality was estimated during 5 years in 101 patients. It was shown that recurrent myocardial infarction is a predictor of high risk of death associated, in the absence of reperfusion therapy, with high intra-hospital and long-term lethality. TD1 soon after recurrent IM does not exclude possibility of its application in a later period. Various interventions including delayed ones markedly decrease the frequency of complications and lethal outcome that remains high in their absence. At the same time, severe lesions of the coronary bed in many patients with recurrent MI limit the possibility of using TDI and should be regarded as indications for planned surgical myocardial revascularization. Coronary bypass surgery after myocardial scarring prevents progress of left ventricle dysfunction, improves its contractility and increases life expectancy. Enhanced availability of reperfusion strategies in the form of TDI and/or delayed surgical myocardial revascularization opens up new possibilities for effective treatment of recurrent Ml.

[Aging, age-related diseases, and certain risk factors of cardiovascular diseases in subjects of advanced and senile age].

The aim of the work was to study sex-specific differences between certain risk factors of cardiovascular diseases and hemodynamic parameters in elderly subjects and their relation to age-specific diseases and genealogic history of longevity. Total cholesterol, triglyceride, glucose, fibrinogen, uric acid, urea, creatinine levels in plasma and arterial pressure (AP) were measured. Hemodynamic parameters were calculated by the formulas for the stroke volume, cardiac output, myocardial contractility, pulse pressure, total peripheral resistance (TPR), endurance factor of cardiac activity, and Kerdo index. Each new decade of life was characterized by peculiar hemodynamic patterns. Pulse AP (PAP) and TPR increased with age and was associated with sex-related metabolic changes. Elderly men presented with hypocholesterolemia and anemia. Total cholesterol, fibrinogen, and glucose levels did not correlate with age. To conclude, elevated PAP, TPR, and left ventricular hypertrophy are risk factors of cardiovascular diseases in old subjects. Combination of several risk factors in young and middle-age subjects reduces prognostic value of the longevity factor in the familial history. Aging is accompanied by the development of gender-related differences in metabolic parameters.

[Longevity: 1. Social, clinical and some metabolic aspects].

We haven't found or identified individual risk factors of cardiovascular diseases (smoking, drinking habit) and a later accession of other risk factors (arterial hypertension, left ventricular hypertrophy, anemia, hyperfibrinogenemia) in nonagenarians with different age-related diseases. This age group was characterized by comorbidity, delayed onset of the disease with fewer complications and some features of metabolism as compared to other age groups. These results enable us to consider longevity as possible model of successful aging.

[Biochemical diagnosis of hereditary hyperlipoproteinemias]. / Biokhimicheskaia diagnostika nasledstvennykh giperlipoproteidemii.

AIM: To specify characteristics of lipoproteins (LPs) metabolism in patients with diverse forms of hereditary hyperlipoproteinemia (HLP) and determine biochemical tests for their differential diagnosis. MATERIALS AND METHODS: According to the criteria of polygenic hypercholesterolemia (PHCE), family combined hyperlipidemia (FCHL), family hypertriglyceridemia (FHTG) and family hypercholesterolemia (FHCE), 157 patients were selected aged 7 to 70 years of 192 examinees (76 patients with primary HLP and 116 their close relatives). Lipids were measured by enzyme methods, apoproteins (apo)--by immunoturbidimetry and immune diffusion. RESULTS: Compared to healthy subjects, PHCE patients were characterized by higher apoB level and proportion cholesterol (CS)/apoB in very low and low density lipoproteins (VLDL and LDL). In unchanged level of high density lipoprotein (HDL) CS and proportion HDLP CS/apoA1 there were reduced quantities of free HDLP CS, HDLP2 CS and apoA1. In FHCE and FCHL there were also low levels of HDL CS in elevated ones of apoE in (VLDL + LDL). However, in FCHL, contrary to FHCE, the proportion SC (VLDP + LDL)/apoB was as in control group. FHTG patients differed from healthy subjects by diminished HDL parameters: lower HDL CS due to free CS and its esters, apoA1 and proportion HDL Cs/apoA. There were no differences with controls by content of apoB and proportion CS (VLDL + LDL)/apoB, apoE levels in different class lipoproteins. CONCLUSION: Biochemical parameters are proposed which can differentiate various forms of hereditary hyperlipoproteinemia.

[Noninvasive investigation of endothelial function in patients with hypertension and hypercholesterolemia (HCE)]. / Neinvazivnoe opredelenie funktsii éndoteliia u bol'nykh gipertonicheskoi bolezn'iu v sochetanii s giperkholesterinemiei.

AIM: Functional assessment of endothelium by endothelium-dependent and non-endothelium dependent response of the brachial artery (BA) in patients with risk factors for atherosclerosis. MATERIALS AND METHODS: The ACUSON 128 XP/10 unit furnished with linear meter with phase grid (7.0 MHz) was employed in two-direction scanning mode to measure BA diameter at rest, under reactive hyperemia (endothelium-dependent response) and after sublingual intake of 0.01 mg of nitroglycerin (non-endothelium-dependent response) in 12 patients with blood hypertension (group 3), 10 subjects with family hypercholesterolemia (group 2) and 10 healthy subjects (group 1, control). RESULTS: The flow-dependent dilatation remained unchanged in BH patients (9.4%) and lowered in HCE patients (3.0%) compared to controls (9.5%). Nitroglycerin-induced dilatation was not significantly different in patients with family hypercholesterolemia (16.6%), hypertensive subjects (14.5%) and healthy controls (20.5%). CONCLUSION: The ultrasound method of detection of endothelial dysfunction is demonstrated. Endothelial dysfunction in patients with familial hypercholesterolemia may contribute to development of atherosclerosis.

[Clinical and biochemical features of atherosclerosis main risk factors in children of probands with primary hyperlipidemia]. / Kliniko-biokhimicheskie osobennosti osnovnykh faktorov riska ateroskleroza u detei probandov s pervichnymi giperlipidemiiami.

AIM: Study of the incidence of hyperlipidemias and coronary atherosclerosis risk factors. MATERIALS AND METHODS: A clinical and biochemical study of 35 children (25 men and 10 women aged 6 to 27 years) from 30 families of probands with primary hyperlipoproteinemias (HLP) was carried out. Use of modified risk factors (RF) in the examined group permitted the detection of hypodynamia in 25 subjects, obesity in 4, alcohol abuse and tobacco smoking in 1, and disorders of lipid metabolism in 31 (88%) cases. RESULTS: Hypercholesterolemia was detected in 26 examinees, combined HLP in 1, hypoalphacholesterolemia in 3, and type V hyperlipoproteinemia in 1 case. The level of lipoprotein (a) was increased and positively correlated with xanthomatosis and the age of examinees. The level of basal immunoreactive insulin was within the normal range of values. Analysis of the relationship of this parameter and other coronary atherosclerosis RF revealed a correlation of the level of immunoreactive insulin and content of blood low-density lipoprotein cholesterol. In only 2 of the 30 examined families of probands with primary HLP there were no disorders of lipid metabolism and other modified RF. CONCLUSION: Children, adolescents, and young people from families with primary HLP represent a risk group; they are to be regularly examined in order to prevent coronary disease and atherosclerosis and to detect and treat it in time.

[A trial of long-term lovastatin treatment in patients with a heterozygous form of hereditary hypercholesterolemia]. / Opyt dlitel'nogo lecheniia lovastatinom bol'nykh s geterozigotnoi formoi nasledstvennoi giperkholesterinemii.

Patients with heterozygous family hypercholesterolemia (HFH) were divided into two groups. Group 1 patients received lovastatin in a daily dose 40-60-80 mg under control of lipids and peripheral blood biochemistry. In 17 patients lovastatin was given as monotherapy, in 15 patients it was combined with plasmapheresis. No hypolipidemic therapy was given to ten patients of group 2. The treatment and follow-up lasted for 4.1 +/- 1.9 years, on the average. A marked hypolipidemic effect was seen in the comorbid therapy. 43% of the patients became resistant to lovastatin, the resistance developed more frequently in monotherapy. The blood fibrinogen fell by 40%, spontaneous and induced platelet aggregation returned to normal, being somewhat higher in subjects resistant to lovastatin therapy. The study shows that hypolipidemic therapy has reduced the risk of IHD fatal complications and progression of non-coronary atherosclerosis in patients of group 1.

[Familial hypercholesterolemia: involvement of cerebral major arteries (communication 1)]. / Semeinaia giperkholesterinemiia: porazhenie magistral'nykh arterii golovnogo mozga.

Ultrasound dopplerography, MR tomography were performed to assess the brain, major cerebral arteries and audiometry was conducted to study cochleovestibular system in 38 patients aged 16-63 years with heterozygous family hypercholesterolemia. Vascular disorders and defects in the white brain matter (in patients with transitory hypertension) were registered. Complications of cerebral atherosclerosis (brain infarction, perception cochleovestibular alterations) contributed to aggravation of ischemic heart disease. Patients with heterozygous family hypercholesterolemia should be observed and treated by cardiologist, neuropathologist and psychoneurologist to prevent cardiocerebral complications.