Effect of Physical Rehabilitation on Echocardiographic Parameters in Patients with Acute Coronary Syndrome.

Echocardiographic parameters were assessed in patients with non-ST segment elevation acute coronary syndrome, who underwent emergency percutaneous coronary intervention followed by various outpatient physical cardiac rehabilitation programs. The patients underwent physical rehabilitation for 3 months under conditions of diagnostic centre in the rehabilitation unit according to the standard program including in treadmill or bicycle exercise in the exercise therapy room or with Nordic walking in the main training block. After rehabilitation course, the left ventricular mass index significantly decreased and systolic volume and left ventricular ejection fraction significantly increased in both groups. Nordic walking training for 3 months non-ST segment elevation acute coronary syndrome induced similar positive shifts in the parameters of intracardiac hemodynamics, as standard treadmill or bicycle training program, which allows considering it as an alternative cardiac rehabilitation method.

[What Are the Realities of Prescription and Control of Antithrombotic Therapy in Atrial Fibrillation in Outpatient Practice?].

We analyzed documentation of 648 outpatients with nonvalvular atrial fibrillation receiving ambulatory care in 3 cities in Russia (Moscow, Krasnodar, and Bryansk). Frequency of use of any anticoagulant in patients with AF and high risk of stroke and systemic embolism was low (30.9% overall, novel oral anticoagulants--5.7%). But portions of patients who according to documents received antiaggregants or no antithrombotic drugs at all were high (53.6 and 13.4%, respectively). Among patients receiving warfarin only 19.6% checked international normalized ratio (INR) every month while 75% did it once in 3 months or rarer or did not control this parameter at all. Among patients in whom INR control was sufficiently regular only in 44% percentage of time in the therapeutic range exceeded 60%. Thus persistent effective anticoagulation was achieved only in 12.6% of warfarin treated outpatients.

[What Are the Realities of Prescription and Control of Antithrombotic Therapy in Atrial Fibrillation in Outpatient Practice?]

We analyzed documentation of 648 outpatients with nonvalvular atrial fibrillation receiving ambulatory care in 3 cities in Russia (Moscow, Krasnodar, and Bryansk). Frequency of use of any anticoagulant in patients with AF and high risk of stroke and systemic embolism was low (30.9% overall, novel oral anticoagulants - 5.7%). But portions of patients who according to documents received antiaggregants or no antithrombotic drugs at all were high (53.6 and 13.4%, respectively). Among patients receiving warfarin only 19.6% checked international normalized ratio (INR) every month while 75% did it once in 3 months or rarer or did not control this parameter at all. Among patients in whom INR control was sufficiently regular only in 44% percentage of time in the therapeutic range exceeded 60%. Thus persistent effective anticoagulation was achieved only in 12.6% of warfarin treated outpatients.

[Pharmacoepidemiology of Statins in Patients With Hypertension and Dyslipidemia].

Aim of the study was to analyze the validity of pharmacoepidemiological purpose and structure of lipid-lowering therapy (LLT) in patients with hypertension and dyslipidemia in clinical practice. Demonstrated commitment to the basic principles of medical verification of cardiovascular events with an adequate definition of risk SCORE scale for patients with high and very high risk. However, the lack of definition of fractions of cholesterol is not allowed to make the right decision on the appointment of GLT for a number of patients with low and moderate risk. The advantage in the appointment of atorvastatin used (32.3%), simvastatin (27.8%) and rosuvastatin (20.9%), and from the antihypertensive subgroups - angiotensin converting enzyme inhibitors, -blockers, calcium antagonists, sartan. Revealed insufficient control of blood lipid in the dynamics on the background of LLT, low activity of doctors in the statin dose titration and use of combined LLT (6.9%) in order to achieve target levels of atherogenic key biochemical parameters. Taking into account the literature data on the most effective and priorities destination rosuvastatin and its high safety in clinical situations of forced polypharmacy we conducted pharmacoeconomic comparison of rosuvastatin several manufacturers of direct cost. Established a price advantage of rosuvastatin (tevastor) with respect to both the original drug, and to a number specified in the prescribing of generics. No fixed assignment LLT is testimony not revealed irrational combinations of drugs with contraindications recommendations, including the appointment of antihypertensive drugs. CONCLUSION: Further work is needed to evaluate pharmacoeconomic indicators LLT, to raise awareness of physicians to enhance quality control of medical assistance and measures to reduce the risk of complications in patients with cardiovascular disease of atherosclerotic origin.

[What physicians think and know about antithrombotic therapy in atrial fibrillation].

We conducted an anonymous survey among 382 physicians (58% internists, 42% cardiologists) in order to obtain information on their opinion on various aspects of antithrombotic therapy in atrial fibrillation. The survey revealed low level of awareness about algorithms of stratification of risks of stroke, systemic embolism, and bleeding. Reported rates of clinical use of recommended antithrombotic agents were: warfarin--30, aspirin monotherapy--19, dabigatran--10, rivaroxaban--8, and combination of aspirin and clopidogrel--8%. Rate of use of drugs without sufficient evidence base in AF was 25%. When asked to designate antithrombotic drug of choice 85% of physicians indicated warfarin and 12%--novel anticoagulants (NOAC). The following factors were considered as limiting wide application of NOAC: high cost (59%), lack of data on these drugs (14%), and impossibility to control safety of their administration (9%).

[Effect of respiratory infections on the clinical course of coronary artery disease].

The subjects of the study were 64 patients with coronary artery disease (CAD), and 38 healthy controls. The study included determination of Chlamydia pneumonia (CLPN), Toxoplasma gondii (TG), Herpes simplex virus (HSV) 1, 2, Epstein-Barr virus (EBV), and antibodies to these microorganisms. Diagnostically significant elevation of the serum levels of IgG antibodies to CLPN, HSV 1, 2, or TG was associated with CAD progression, and seropositivity to several of the agents strongly correlated with CAD progression. Moreover, the risk of future coronary events increased depending on the level of total pathogen burden. These results suggest that intracellular infectious agents are involved in the development of atherosclerosis and CAD.

[Polymorphisms of angiotensin converting enzyme and angiotensin II type 1 receptors genes and the state of regional hemodynamics in borderline arterial hypertension in young men]. / Molekuliarnaia organizatsiia genov angiotenzinprevrashchaiushchego fermenta i retseptorov 1-go tipa angiotenzina II i sostoianie regionarnoi gemodinamiki pri arterial'noi gipertenzii 1-i stepeni u molodykh muzhchin.

Relationship between polymorphisms of ACE and ATR1 genes to morphological and functional states of cardiovascular system was studied in young men with borderline hypertension living in north-west region of Russia. Prevalences of ACE DD and ATR1 AC genotypes were 46 and 54%, respectively. There were no significant correlations between genotypes studied and parameters of central, intracardiac, ophthalmic hemodynamics, as well as presence and severity of albuminuria. Compared with other gene combinations simultaneous carriers of DD and CC genotypes had significantly more pronounced changes of target organs.

[Characteristics of hemodynamics and metabolism and structural polymorphisms of angiotensin converting enzyme and angiotensin II type I receptors genes in women of childbearing]. / Osobennosti gemodinamiki, metabolizma i strukturnyi polimorfizm genov angiotenzinprevrashchaiushchego fermenta i retseptorov 1-go tipa angiotenzina II u zhenshchin detorodnogo vozrasta pri arterial'noi gipertenzii 1-i stepeni.

Parameters of systemic and intracardiac hemodynamics, characteristics of metabolism, and structural polymorphisms of angiotensin converting enzyme (ACE) and angiotensin II type 1 receptor (ATR(1)) genes were studied in women of childbearing age and men of the same age both with first degree hypertension. Women had lower mean 24-hour blood pressure (BP), greater BP variability, preponderance of "dipper" variant of 24-hour systolic and diastolic BP profile, higher prevalence of left ventricular hypertrophy, lower blood levels of cholesterol, triglycerides, urea and potassium. Among women A allele of ATR(1) gene was significantly more frequent than C allele. Comparison of ATR(1) gene polymorphisms in women and men showed that frequencies of AA genotype and A allele were higher in women. Presence of DD genotype of ACE gene in women was related to parameters of both hemodynamics and metabolism, whereas that of II genotype of ACE gene as well as AA and AC genotypes of ATR(1) gene were linked with parameters of hemodynamics.