[On the use of statins in patients with chronic cardiac insufficiency].

Today, the necessity to use hypolipidemic agents belonging to the group of statins as means of primary and secondary prevention of coronary artery disease (CAD) and its complications is not doubted. The results of numerous large studies conducted in many different countries during the last 10 to 15 years confirm this statement. The appropriateness of statin application to patients with chronic cardiac insufficiency (CCI) is still under discussion, because there are no sufficient data on whether hypolipidemic therapy is able to improve the prognosis in this category of patients. The authors conducted a long-term research into the use of statins in combination with basic combined therapy in patients with CCI complicating the course of CAD. A reverse correlation between the levels of total cholesterol, low-density protein cholesterol, and the degree of CCI severity was demonstrated. Long-term continuous therapy of CCI patients with a combination of medications including statins did not worsen the clinical symptoms. However, hypolipidemic therapy should be administered to CCI patients on a differentiated basis, taking into account the initial state of lipid profile and the severity of the underlying disease.

[Endothelial dysfunction in patients with chronic heart failure, and possibilities of its correction with isosorbide-5-mononitrates].

Vascular endothelial dysfunction has been proven to play an important role in the development and progression of chronic heart failure (CHF). The influence of isosorbide-5-mononitrate monocinque on endothelial function in patients with NYHA II class chronic heart failure complicating the course of coronary artery disease (CAD) with II--III class stable exertional stenocardia was studied. Disturbances in endothelium-dependent vasodilation in a form of a lowered endothelial response to an increase in shift tension during reactive hyperthermia test were noted in patients with CHF complicating CAD. After 12 weeks of treatment with monocinque endothelium-dependent vasodilation normalized, which manifested by an increase in the vasodilating response of the brachial artery to stimulation with an increased flow from 8.2 +/- 1.3 to 11.1 +/- 1.0%. Monocinque administered in a day dose of 40 mg possessed antianginal activity in 85.7% of patients: the frequency of anginal attacks lowered by 59.3%, morphofunctional heart parameters improved which manifested by a 8.7% increase in ejection fraction. Side effects of monocinque, typical of nitrates, were noted in 17.9% of patients and did not require discontinuation of the therapy.

[Efficacy and Safety of a Domestic Non-selective b-adrenoblocker Possibilities of the Use of Proxodolol in the Treatment of Patients With Chronic Heart Failure.].

Novel (made in Russia) nonselective b-blocker with a1-blocking properties proxodolol was given to 30 patients with ischemic heart disease, NYHA class II-III chronic heart failure (CHF) and left ventricular ejection fraction (LVEF) <40%. Methods of control included clinical examination, registration of hemodynamic and morphofunctional parameters of the heart. Proxodolol caused clinical improvement which appeared as reduction of signs of CHF and betterment of myocardial contractile function with 14% increase of LVEF according to data of echocardiography. Side effects of proxodolol were noted in 26.7% of cases and required withdrawal of the preparation in 6.7% of patients.

[Novel possibilities of antithrombotic therapy in patients with chronic heart failure].

Modern approaches to prevention of venous thromboembolic complications in patients with chronic heart failure are analyzed in this review which contains results of large studies of low molecular weight heparins. In MEDENOX trial the use of enoxaparin in medical patients was associated with 63% reduction of risk of thrombosis. The authors own experience showed that 2 weeks of therapy with enoxaparin in patients with chronic stage IIB-III heart failure caused significant lowering of soluble fibrin-monomer complexes, fibrinogen, and index of turbo-dynamic potential. These changes evidenced for decreased intravascular blood coagulation. Thus enoxaparin can be effectively used for prevention of thrombosis and thromboembolism in patients with chronic heart failure. Novel antithrombotic agents fondaparinux, idraparinux, ximelagatran, recombinant thrombomodulin are perspective medications for prevention of venous thromboses and embolism in medical patients.

[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.

[Blood pressure 24-hour rhythms and variability in adolescents with hypertension]. / Osobennosti sutochnykh ritmov arterial'nogo davleniia i ego variabel'nosti u podrostkov s arterial'noi gipertenziei.

Twenty-four hour blood pressure (BP) monitoring was used for the study of BP 24-hour rhythms and variability in adolescents with hypertension and their normotensive counterparts. The data obtained evidenced for active participation of sympatho-adrenal system in genesis of juvenile hypertension: hypertension was predominantly systolic, BP elevation as a rule was associated with increased heart rate and pulse pressure. Episodes of BP elevation were registered mostly during day time. Desynchronization of 24-hour rhythms due to pronounced BP lowering during sleep characteristic for this age group found its reflection in values of nocturnal BP dipping. More than 1/3 of adolescents with episodes of elevated BP had 'white coat' hypertension.

[Tumor necrosis factor in blood plasma and morphofunctional parameters of the hart in patients with chronic heart failure complicated by a course of ischemic heart disease. Dynamics under effect of treatment]. / Faktor nekroza opukholei v plazme krovi i morfofunktsional'nye parametry serdtsa u bol'nykh s khronicheskoi serdechnoi nedostatochnost'iu oslozhnivshei techenie ishemicheskoi bolezni serdtsa. Dinamika pod vliianiem lecheni.

AIM: To examine the course of chronic cardiac failure (CCF), morphofunctional parameters of the heart in correlation with activity of cytokine system; to evaluate effectiveness, tolerance and safety of combined CCF treatment including a cardioselective beta-adrenoblocker bisoprolol in patients with CCF FC I-IV having a high plasm level of tumor necrosis factor alpha (TNF-alpha). MATERIAL AND METHODS: The concentration of TNF-alpha in plasm of 40 patients with IHD complicated by CCF of FC I-IV and ejection fraction under 45% was measured at enzyme immunoassay. The treatment included combined therapy with diuretics, cardiac glycosides, peripheral vasodilators, ACE inhibitors, bisoprolol (group I) or no bisoprolol (group II). RESULTS: CCF patients with TNF-alpha had a significantly reduced IMT, more frequent episodes of CCF decompensation, longer CCF history, lower EF and threshold exercise intensity. In group I patients all these parameters improved. CONCLUSION: CCF patients with elevated plasm levels of TNF-alpha showed a severe course of the disease, low IMT, abnormal myocardial contraction and exercise tolerance. The addition of bisoprolol to combined treatment of the above patients improves their clinical condition, morphological parameters of the heart and exercise tolerance.

[Efficacy, safety, and pharmaco-economical aspects of the therapy for dyslipidemia with brand-name and generic statins]. / Effektivnost', bezopasnost' i farmakoékonomicheskie aspekty lecheniia dislipidemii original'nym i genericheskim statinami.

AIM: To compare clinical, cost-effect efficacies and safety of simvastatin Zokor and generic Vasilip in correction of dislipoproteinemia in patients with ischemic heart disease. MATERIAL AND METHODS: The original statin Zokor and generic statin Vasilip were given for 8 weeks in a dose 20 mg/day. RESULTS: Vasilip and Zokor demonstrated similar hypolipidemic efficacy and safety, but Vasilip administration was more cost-effective. CONCLUSION: Simvastatin Vasilip is recommended for wider use in clinical practice because it is clinically and cost effective.

[Peculiarities of blood pressure rhythms and blood pressure variability in adolescents with hypertension (in accordance with twenty-four monitoring of blood pressure)]. / Osobennosti sutochnykh ritmov arterial'nogo davleniia i ego variabel'nosti u podrostkov s arterial'noi gipertenziei (po dannym sutochnogo monitorirovaniia AD).

Registration of 24-hour blood pressure in adolescents with and without hypertension revealed active participation of sympathetic nervous system in genesis of juvenile hypertension. Hypertension in adolescents was mainly systolic, blood pressure elevation as a rule was accompanied by accelerated heart rate and increased pulse pressure. Episodes of blood pressure elevations occurred mostly during day time. Desynchronization of 24-hour rhythms due to excessive nocturnal blood pressure lowering was found to be typical for this age group. More than two thirds of adolescents with episodes of blood pressure elevation had also 'white coat hypertension'.

[24-Hour arterial pressure profile in chronic obstructive lung diseases in combination with arterial hypertension treated with enalapril]. / Dinamika sutochnogo profilia arterial'nogo davleniia pri khronicheskikh obstruktivnykh bolezniakh legkikh v sochetanii s arterial'noi gipertoniei na fone lecheniia énalaprilom.

AIM: To evaluate peculiarities and trends in 24-hour arterial pressure (AP) profile and bronchoobstructive syndrome (BOS) in patients with chronic obstructive pulmonary diseases (COPD) and arterial hypertension (AH) on combined treatment including enalapril maleate. MATERIAL AND METHODS: Changes in BOS as shown by clinical data, data of peakflowmetry and external respiration function as well as in AP 24-hour profile according to 24-hour monitoring were studied in 50 patients with exacerbation of bronchial asthma and chronic bronchitis treated for 4 weeks with conventional broncholytic and antiinflammatory modalities, in 28 patients with mild and moderate AH receiving combined therapy including enalapril maleate. RESULTS: In exacerbation of COPD, 24-h AP profile is characterized by high frequency of the curve "non-dipper". Concomitant mild and moderate AH was diagnosed in more than half of the examinees. The addition of enalaprile maleate to the treatment in many cases lowered systolic and diastolic AP, normalized sympathicoadrenal system and 24-hour AP rhythm, reduced dyspnea, improved exercise tolerance, sleep. Good tolerance of the drug was seen in patients with exacerbation of COPD. CONCLUSION: In exacerbation of COPD it is recommended to monitor AP for 24 hours for early detection of AH and initiation of combined treatment with correction of bronchoobstructive syndrome and hemodynamic disorders. As a hypotensive drug, enalapril maleate is adequate in such patients.

[Prospects of use of the combined preparation logimax in patients with essential hypertension]. / Perspektivy primeneniia kombinirovannogo preparata logimaks u bol'nykh éssentsial'noi arterial'noi gipertoniei.

AIM: To study the effectiveness and tolerance of a combined drug logimax in patients with essential hypertension (EH). MATERIAL AND METHODS: The antihypertensive activity and safety of logimax was evaluated in 15 EH patients at week 10 of therapy. RESULTS: Logimax has a good antihypertensive effect for 24 hours in 86.7% patients. This was evidenced by the lowered mean systolic and diastolic pressures shown during 24-hour monitoring. Logimax was well tolerated. There were no side effects in 73.3% of the patients. CONCLUSION: The combined drug logimax is indicated for patients with EH as an antihypertensive agent to treat and prevent cardiovascular events.

[Effects of perindopril and its combination with indapamide on risk stratification in patients with hypertension]. / Vliianie perindoprila i ego kombinatsii s indapamidom na stratifikatsiiu riska u bol'nykh gipertonicheskoi bolezn'iu.

AIM: To study effects of perindopril, indapamid and their combination on stratification of essential hypertension (EH) risk factors. MATERIAL AND METHODS: The 10-year risk to develop cardiovascular complications was assessed in 85 EH patients before and after 12 months of treatment with perindopril, indapamid and their combination. RESULTS: The high risk of cardiovascular complications in the above patients reduced by 21.5, 14.8 and 26.6% 12 months after treatment with perindopril, indapamid and their combination, respectively. CONCLUSION: Low risk of cardiovascular complications was related not only with a fall in systolic and diastolic blood pressure but also with positive effect on left ventricular hypertrophy, absence of negative influence on total cholesterol, glucose in blood plasma.

[Circadian rhythms of hemodynamic load on the cardiovascular system in patients with essential hypertension: implication for drug therapy rationale]. / Tsirkadiannyi ritm gemodinamicheskoi nagruzki na serdechno-sosudistuiu sistemu u bol'nykh éssentsial'noi arterial'noi gipertenziei -- znachenie dlia ratsional'noi farmakoterapii.

Circadian rhythm of hemodynamic load by double product (heart rate x systolic blood pressure) was studied in 224 patients with essential hypertension (EH) treated with different antihypertensive drugs for 8-12 weeks and in 23 healthy subjects. The main feature of the rhythm was a marked morning rise in all the patients including non-dippers and night-peakers without nocturnal blood pressure fall. The examined drugs showed different effects on mean 24-h and morning values of the double product.

[Combined use of zolpidem and enalapril in elderly patients with essential arterial hypertension and sleep problems]. / Kombinirovannoe primenenie zolpidema i énalaprila u pozhilykh lits s éssentsial'noi arterial'noi gipertenziei i narusheniiami sna.

Changes in 24-h profiles of arterial pressure following treatment with zolpidem were studied in 12 patients with essential arterial hypertension and chronic sleep problems on enalapril. One week treatment with zolpidem improved quality of sleep, increased a circadian index of systolic arterial pressure, 3 non-dipper patients recovered circadian rhythm of arterial pressure. The antihypertensive effect at night was higher when enalapril was used in combination with zolpidem than in monotherapy with enalapril.