[Pleiotropic effects of atorvastatin in rheumatoid arthritis patients with no history of cardiovascular diseases].

AIM: To evaluate the effect of atorvastatin (liprimar) on the laboratory values of inflammation and blood lipid composition in rheumatoid arthritis (RA) patients with no history of cardiovascular diseases (CVD). Subjects and methods. Fifty women with grade II RA activity according to DAS28 and radiologic (erosive) Stages I-III were examined; the patients were not former or current smokers; all were seropositive; their mean age was 50.2±9.9 years. All the patients with RA were divided into 2 groups: Group 1 took no atorvastatin and continued to receive standard previously prescribed therapy; Group 2 used atorvastatin in a dose of 20 mg. Lipidogram readings and the levels of Apo-A and Apo-B, neopterin, tumor necrosis factor-α, C-reactive protein, sP-selectin, sE-selectin, interleukin (IL)-6, IL-10, IL-12, and matrix metalloproteinases 3 and 9 were assessed. RESULTS: The patients with RA show obvious blood lipid composition impairments. Incorporation of atorvastatin (liprimar) into combination therapy for RA not only causes a considerable reduction in total cholesterol, low-density lipoprotein cholesterol, triglycerides, and apo-B levels, but also positively affects the inflammatory activity of the disease, by lowering the level of proinflammatory cytokines and increasing that of the anti-inflammatory cytokine IL-10. CONCLUSION: The above changes may underlie the prevention of CVD complications in patients with RA.

[Combined antihypertensive therapy in patients with arterial hypertension and type 2 diabetes].

The aim of the study was to assess effect of 12-week long combined therapy with quinapril (accupro), an ACE inhibitor, and diuretic indapamide SR on arterial pressure (AP), carbohydrate and lipid metabolism, and safety of the treatment in patients having arterial hypertension (AH) with and without DM2. Sixty outpatients with grade II-III AH (mean age 55.3 +/- 9.6 yr) were divided into 2 groups: group 1 (n = 30) comprised patients with AH and DM2, group 2 (n = 30) included patients with AH alone. Combined therapy with daily doses of 23.3 +/- 9.8 g accupro and 1.5 mg indapamide reduced systolic and diastolic AP by 30.2 and 27.3% respectively in group 1 and by 27.6 and 27.1% in group 2. In patients with AH and DM2, fasting and postprandial blood glucose levels decreased by 7.3 and 5.2% and HbA1c by 8.9% (p < 0.05). Total cholesterol, triglycerides, and LDL cholesterol tended to decrease in both groups. HDL cholesterol significantly (p < 0.05) increased by 11.1% in group 1 and 10% in group 2 Side effects were documented only in 8.3% of the patients and did not require withdrawal of therapy. It is concluded that antihypertensive treatment with quinapril (accupro), an ACE inhibitor, and diuretic indapamide SR may be recommended for long-term therapy of AH concomitant with DM2.

[Combined antihypertensive treatment of patients with hypertension and type 2 diabetes mellitus].

AIM: To investigate antihypertensive efficacy, effects on endothelial, diastolic function of the left ventricle and metabolism of combination of ACE inhibitor quinapril (accupro) with diuretic indapamide SR in patients with hypertension of the second-third degree and type 2 diabetes mellitus (DM) and free of DM. MATERIAL AND METHODS: Outpatient treatment was given to 60 patients with AH (mean age 55.3 +/- 9.6 years) in combination with mild or moderate DM (group 1) and free of DM (group 2). The patients were observed for 12 weeks. Clinical and biochemical blood tests, ECG, echo-CG, measurements of blood pressure were made in all the patients. RESULTS: Quinapril course (mean dose 23.3 +/- 9.8 mg/day) in combination with indapamide (1.5 mg/ day) produced a complete hypotensive effect in group 1 (23 patients, 76.7%), in group 2--25 (83.3%). DM patients demonstrated reduction of fasting and postprandial glycemia and cholesterol, time of isovolumic relaxation reduced in group 1 by 9.1%, in group 2 by 19.8% (p < 0.01). Left ventricular diastolic function improved, endothelium-dependent vasodilation in diabetics rose by 40%, non-endothelium-dependent--by 21.8%, in hypertensive patients free of DM--by 51.9 and 43.2%, respectively. CONCLUSION: Combination of quinapril with indapamide produces a significant antihypertensive effect in patients with AH of degree II-III associated with type 2 DM, improves carbohydrate and lipid metabolism, left ventricular diastolic function.

[Heart failure in the practice of primary health care in Kemerovo].

AIM: To study quality of therapy of chronic heart failure (CHF) patients in primary health care institutions of Kemerovo city. MATERIAL AND METHODS: Records for 200 outpatients with CHF admitted to cardiological departments of Kemerovo hospitals were analysed. The treatment quality was assessed by special sheets reflecting treatment of CHF patients. RESULTS: CHF most frequently resulted from ischemic heart disease and arterial hypertenion (67.6 and 18.9% patients, respectively). Among medicines, ACE inhibitors in subnormal doses were used most frequently (70.9%), less often were administered disaggregants (52.4%), beta-adrenoblockers in low doses (50.4%), diuretic drugs (43.3%), cardiac glycosides (16.5%) and aldosteron antagonists (28.6%). Calcium antagonists were prescribed to 19.7%, metabolic medication--to 22.1%, nitrates --to 37.8% patients. CONCLUSION: As a rule, CHF treatment in outpatient clinics of Kemerovo was made according to national standards except underestimation of beta-adrenoblockers, cardiac glycosides and too frequent administration of calcium antagonists and some metabolic drugs.