[Gene IL6 G(-174)C and gene IL10 G(-1082)A polymorphisms are associated with unfavourable outcomes in patients with acute coronary syndrome].

We investigated the association of gene IL6 G(-174)C polymorphism and gene IL10 G(-1082)A polymorphism with coronary artery disease (CAD) in the Russian population. A total of 1145 patients with CAD diagnose on the basis of clinical studies in cardiological hospitals of Moscow, St -Petersburg, Kazan, Chelyabinsk, Perm, Stavropol and Rostov-on-Don. Supervision term was 9.10 +/- 5.03 months (the maximum term 18 months). In case of gene IL10 G(-1082)A polymorphism we determined that patients with CAD diagnose and A alleles gene IL10 had unfavorable outcome more often than patients with homozygous G alleles. Survival time from end point from carrier genotype GA and AA is 11.68 +/- 0.67 months against 12.69 +/- 0.65 months from carrier phenotype GG gene IL10 (chi2 = 4.13, p = 0.042). The group studied do not differ significantly with respect to the distributions of gene IL6 G(-174)C alleles and genotypes. However in case combined group studies of gene IL10 G(-1082)A polymorphism and IL6 G(-174)C polymorphism we determined that patients with CAD diagnose and carrier genotype GG gene IL6 and genotype GA and AA gene IL10 had unfavorable outcome more often (survival time 11.01 +/- 1.24 months) than patients with genotype CC and CG gene IL6 and genotype GG gene IL10 (survival time 13.28 +/- 0.83 months) chi2 = 10.23, p = 0.017. The obtained data allows assuming the important role of the IL6 and IL10 genes which are responsible for functioning of inflammation system, in the accelerated formation of failures at the patients who had a coronary syndrome.

[Polymorphic markers G(-455)A of gene FGB and C(-1654)T of gene PROC and genetic predisposition to unfavorable outcomes patients undergoing acute coronary syndrome].

We investigated the association of polymorphisms of genes FGB G(-455)A and PROCC(-1654)T with coronary artery disease (CAD) in the Russian population. A total of 1145 patients with CAD diagnose on the basis of clinical studies in cardiological hospitals of Moscow, St. Petersburg, Kazan, Chelyabinsk, Perm, Stavropol and Rostov-on-Don. Supervision term was 1.14 +/- +/- 0.33 years (the maximum term 3.2 years). The group studied do not differ significantly with respect to the distributions of G(-455)A alleles and genotypes. However in case of gene PROC C(-1654)T polymorphism we determined that patients with CAD diagnose and Talleles of PROC gene had unfavorable outcome more often than patients with homozygous C alleles. Survival time from end point from carrier phenotype TT and CTis 2.19 +/- 0.18 r. years against 2.46 +/- 0.16 from carrier phenotype CCgene PROC. The obtained data allows to assume the important role of the genes which are responsible for functioning of system of a hemostasis, in the accelerated formation of failures at the patients who had a coronary syndrome.

[Clinical and vascular effects of ACE inhibitor enalapril in combination with thiaside-like diuretic indapamide in hypertensive outpatients. Results of the multicenter trial POEMA].

AIM: To evaluate efficacy and safety of a 6-month treatment of 237 patients with arterial hypertension (AH) of degree 1-3 with ACE inhibitor enalapril (mean dose 21.9 +/- 9.0 mg/day), 49.4% of which received adjuvant indapamide (2.5 mg/day), to study effects of this therapy on rigidity of the major arteries by dynamics of pulse wave velocity (PWV) and US rigidity index beta (RIB). MATERIAL AND METHODS: The study included only patients with initially elevated PWV which was detected in 266 (53%) of 501 examinees. RESULTS: Lowering of systolic and diastolic blood pressure (BP) was 16.8 and 14.0% to treatment month 3 and, in addition, 1.6 and 1. 7% to month 6, respectively (p < 0.001). Target BP (< or = 140/90 mm Hg) was achieved in 82.7% patients. During the trial 3 (1.2%) patients withdrew because of severe cough. Slowdown of PWV measured by brachiomalleolar (PWVbm) and carotid-femoral (PWVcf) methods was equal in the course of the trial and made up 2.45 and 6.1% to treatment month 3 (p < or = 0.05 for both) and additional 3.25 and 7.4% to month 6 (p < 0.001 for both), respectively. High PWV normalized completely in 42.6% patients. After 6 months of the trial US RIB decreased by 30.5% (p < or = 0.001). The correlation analysis detected a significant correlation between SAP fall and PWV decrease only during the first 3 months of therapy (r = 0.402, p = 0.005). In month 3-6 the correlation became insignificant (r = 0.28, p = 0.055). CONCLUSION: Combination of enalapril and indapamide is effective and safe in outpatients with arterial hypertension of the first-third degree and baseline high rigidity of the vascular wall. This treatment reduces PWV and rigidity of the major arteries associated with BP lowering (in the treatment month 1-3) and a vasoprotective effect of the drugs.

[Advantages of long-term controlled stepwise therapy of arterial hypertension with the use of angiotensin converting enzyme inhibitor spirapril].

AIM: Achievement of long-term effective control of blood pressure (BP) in patients suffering from arterial hypertension by means of elaboration of stage by stage program of antihypertensive therapy and proof of its advantage over prescription of hypotensive drugs in real clinical practice. MATERIAL AND METHODS: Effect of spirapril on parameters of vasomotor function of the endothelium were assessed. In randomized comparative prospective study with 1 year duration we included patients with mild and moderate arterial hypertension. The study group received stepwise antihypertensive therapy based on angiotensin converting enzyme inhibitor spirapril. Comparison group continued to take hypotensive drugs prescribed in conditions of outpatients clinic. RESULTS: Sixty patients (79.6% women) were included in the study (30--in the study group, 30--in comparison group). Lowering of BP was observed in the process of therapy in both groups. Among patients of spirapril group lowering of BP was more pronounced and occurred more quickly with achievement of target level of systolic BP <140 mm Hg and diastolic BP <80 1 month after beginning of treatment. Under the influence of therapy with spirapril for 6 months improvement of function of the endothelium was noted. CONCLUSION: In the process of stepwise therapy with the use of spirapril effective long-term control of BP is more quickly achieved compared with standard treatment of arterial hypertension, and improvement of vasomotor function of endothelium also occurs.

[Efficacy and safety of simvastatin in patients with hypercholesterolemia (results of a Multicenter Clinical Study)]. / Effektivnost' i bezopasnost' simvastatina u patsientov s giperkholesterinemiei (rezul'taty mnogotsentrovogo klinicheskogo issledovaniia).

AIM: To assess efficacy and safety of a generic preparation of simvastatin Vasilip (KRKA) in ischemic heart disease patients with hypercholesterolemia or combined hyperlipidemia. MATERIAL: Patients (n=167, age 36-73 years) with ischemic heart disease and moderate hypercholesterolemia or combined hyperlipidemia. METHODS: Duration of simvastatin administration was 12 weeks. All patients received 20 mg/day for 6 weeks. Then those patients who did not achieve target low density lipoprotein (LDL) cholesterol level (3.0 mmol/l) were given 40 mg/day for 6 more weeks. Other patients continued to take 20 mg/day. RESULTS: The use of Vasilip was associated with lowering of total, LDL cholesterol and triglycerides (by 28, 39 and 10%, respectively) and 18% elevation of high density lipoprotein cholesterol. Target LDL CH level was achieved in 107 patients (66.9%). In 47 patients (29.4%) LDL CH concentration remained higher than target level but decrease of LDL CH exceeded 10%. Six patients (3.8%) did not respond to therapy. Treatment was stopped because of adverse effects in 2.4% of patients. CONCLUSION: A generic preparation of simvastatin Vasilip in a 12-week open noncomparative study demonstrated substantial lipid lowering activity and did not induce serious adverse reactions.

[Lipid peroxidation as an indicator of the effectiveness of treating patients with chronic ischemic heart disease using a helium-neon laser]. / Perekisnoe okislenie lipidov kak pokazatel' éffektivnosti lecheniia gelii-neonovym lazerom bolnykh khronicheskoi ishemicheskoi bolezn'iu serdtsa.

A therapeutic response to clinical application of Helium-Neon laser irradiation in combination with antianginal drugs was evaluated for chronic sufferers with coronary heart disease (CHD). The largest scope of information on the efficacy of the laser therapy has been provided by the parameters of lipid peroxidation. Individually adjusted doses of the irradiation allowed achievement of the best treatment results.

[Shock lung syndrome in myocardial infarct (electron microscopic and biochemical study)]. / Sindrom shokovogo legkogo pri infarkte miokarda (élektronno-mikroskopicheskoe i biokhimicheskoe issledovanie).

A comprehensive clinical sample (375 cases of myocardial infarction, with uncomplicated course in 115, pulmonary edema in 80, cardiac asthma in 37, pulmonary edema combined with cardiogenic shock in 55, and other complications in 88; 89 fatal cases altogether) was used to demonstrate that the shock lung associated with myocardial infarction was rooted in strained operation of various pulmonary functions other than gaseous exchange and inadequate inactivation of vasoactive substances (histamine, serotonin, kinins). The ultrastructural pattern of the shock lung is characterized by damaged aerohematic barrier edema, hypercoagulation, atelectases and the sludging of aggregated erythrocytes. Acute respiratory insufficiency is not always associated with cardiogenic shock and may develop spontaneously in myocardial infarction.

[Ultrastructural bases of pulmonary edema in myocardial infarct]. / Ul'trastrukturnye osnovy oteka legkikh u bol'nykh infarktom miokarda.

A total of 347 patients with myocardial infarction were investigated. Of those, 115 had uncomplicated course of the disease, while pulmonary edema developed in 80, cardiac asthma in 37, pulmonary edema and cardiogenic shock in 35, and various other complications in 80; the outcome was lethal in 80 cases. The pathogenetic contribution of increased permeability to the development of myocardial infarction and its complications is demonstrated. Transendothelial pinocytosis is a trigger mechanism of pulmonary edema. Its pathomorphism is achieved in five steps, each corresponding to a certain degree of ultrastructural transformation of endothelial and alveolar cells. Pulmonary surfactant damage adds to the effect of tissue factors of increased aerohematic barrier permeability.

[Effect of drugs on the permeability of the histohematic barriers in a complicated course of myocardial infarct]. / Medikamentoznoe vozdeistvie na pronitsaemost' gistogematicheskikh bar'erov pri oslozhnennom techenii infarkta miokarda.

The investigations have shown the pathogenetic role of enhanced capillary permeability on the development of myocardial infarction and its complications. To a definite degree the above disorders are conditioned by the activation of the kallikrein-kinin system. This made us try contrykal with heparin in the comprehensive system of treatment of these patients. A clear-cut clinical and laboratory effect has been obtained which justifies recommending the use of protease inhibitors in complicated myocardial infarction.