[Effects of lovastatin therapy on the level of low density lipoproteins and atherogenic potential of serum in patients with ischemic heart disease and hypercholesterolemia]. / Vliianie terapii lovastatinom na uroven' lipoproteidov nizkoi plotnosti i aterogennyi potentsial syvorotki krovi bol'nykh ishemicheskoi bolezn'iu serdtsa s giperkholesterinemiei.

The serum atherogenic potential in patients with coronary heart disease (CHD) concurrent with hypercholesterolemia (LDL cholesterol more than 200 mg/dl), which is able to cause accumulation of intracellular cholesterol in cultured cells has been recently shown to be directly related to the level of total cholesterol and LDL cholesterol. The study was undertaken to examine how a lovastatin-induced decrease in LDL levels affects serum atherogenicity in patients with CHD and hypercholesterolemia. It was shown that the therapy of 22 patients with CHD and hypercholesterolemia led to a reduction in total and LDL cholesterol levels on an average by 24% and 32%, respectively. There were 3- and 1.5-2-fold decreases in circulatory immune complexes and the atherogenic potential, respectively. The findings suggest that the significant reduction in serum LDL cholesterol levels in patients with CHD concurrent with hypercholesterolemia who take hypolipidemic therapy is followed by a decrease in the atherogenic potential.

[Restriction polymorphism in patients with lipid metabolism disorders and ischemic heart disease]. / Issledovanie restriktsionnogo polimorfizma genov apoB u bol'nykh s narusheniiami lipidnogo obmena i ishemicheskoi bolezn'iu serdtsa.

Using the RELP analysis we studied the frequency of X2 allele of apoB gene in three groups of patients: 1) men at the age of 20-59 with lipid metabolism disorders revealed in population inspection of Oktyabrsky district in Moscow; 2) men with ischaemic heart disease and 3) healthy men. It was established that in individuals suffering from type IIa hyperlipidemia the frequency of X2 allele was significantly higher than in healthy donors from Moscow population. Homozygotes for X2 allele of XbaI RELP had 7-9% higher serum cholesterol levels, than homozygotes for X1 allele. The study suggests the X2 allele of the apoB gene to be associated with the development of high plasma cholesterol level. No significant difference in X2 allele frequencies was found between patients with ischaemic heart disease and healthy donors. There was also no association found between cholesterol and triglyceride levels and the presence of X2 allele in this group of patients.

[HLA-associated susceptibility to ischemic heart disease]. / Assotsiirovannaia s HLA predraspolozhennost' k ishemicheskoi bolezni serdtsa.

Tissue typing was used to study characteristic features of class I and II HLA-antigens distribution in two populations of young IHD patients: Russians (n-32) and Georgians (n-72). Healthy donors (267 Russians and 579 Georgians) served as controls. Genetic markers of IHD predisposition are revealed: for Russians relative risk for B12, DR1 equaled 2.95 and 3.65, respectively, and for Georgians 6.60, 3.02 and 2.33 for B21, Bw22 and DR2, respectively. The differences in markers of IHD predisposition in two populations belonging to the same race suggest than IHD predisposition gene in each population may be bound to various HLA antigen(s). This necessitates study of the markers not only in each race, but in each population as well.

[Results of a 10-year prospective study of patients with ischemic heart disease]. / Rezul'taty 10-letnego prospektivnogo nabliudeniia za bol'nymi ishemicheskoi bolezn'iu serdtsa.

The paper analyses the results of a 10-year prospective study of 396 patients with coronary heart disease concurrent with stable angina pectoris of different functional classes without serious concomitant diseases. In all the patients. coronary angiography revealed stenosis of one-to-three great coronary arteries and ventriculography showed no severe abnormalities in left ventricular contractility. A long-term drug therapy promoted not only improvement of the clinical status in most patients, but maintenance of work capacity and increase of their lifespan. The annual mortality rate was 3.0%, the incidence of nonfatal myocardial infarction was 5.9%. Repeated coronary angiography indicated that progression of coronary atherosclerosis was accompanied by a clinical deterioration in the patients' health and a decrease in exercise tolerance.

[A comparative evaluation of loading tests for the diagnosis of ischemic heart disease at the prehospital stage]. / Sravnitel'naia tsennost' prob s nagruzkoi dlia diagnostiki ishemicheskoi bolezni serdtsa na dogospital'nom étape.

Bicycle ergometry, the treadmill test, transesophageal pacing of the left atrium and 24-h monitoring of the ECG were performed on an outpatient basis in 82 persons (all men) with angina pectoris of effort and stenosing atherosclerosis of the coronary arteries verified with the aid of selective coronarography and in 17 men with intact coronary arteries. Transesophageal pacing and the treadmill test exhibited the highest sensitivity (94 and 89%, respectively) in the diagnosis of the latent forms of coronary failure. The sensitivity of bicycle ergometry (77%) was significantly lower which was caused by a considerable number (21%) of tests completed before the appearance of diagnostic criteria. Meanwhile the results of 24-h monitoring of the ECG (65% sensitivity) depended on the degree of the patients' physical activity and way of life. All the four methods did not significantly differ in the specificity. Proceeding from the data obtained it is recommended that the treadmill test and transesophageal pacing of the heart may be widely used on an outpatient basis to diagnose coronary disease.

[The effect of lovastatin therapy on the dynamics of the clinical state of patients with ischemic heart disease and hyperlipoproteinemia]. / Vliianie terapii lovastatinom na dinamiku klinicheskogo sostoianiia bol'nykh ishemicheskoi bolezn'iu serdtsa s giperlipoproteidemiei.

The authors review the results of the clinical use of lovastatin in 150 patients with associated coronary heart disease and coronary atherosclerosis (according to coronarography). All the patients suffered from primary non-familial hyperlipoproteinemia (of the IIa and IIb types) and were entered into the placebo-controlled studies of the effectiveness of lovastatin. After 3 months of the treatment there was a decrease in the levels of total cholesterol (by 36%) (p less than 0.001); the content of cholesterol LDLP dropped by 48% (p less than 0.001), and that of triglycerides by 19% (p less than 0.01), while the level of cholesterol HDLP rose. Side effects were recorded in an insignificant number of cases. Therefore, lovastatin is a highly effective and well tolerable drug for the treatment of patients with coronary heart disease and hyperlipoproteinemia.

[The effectiveness of the hypolipemic preparation lovastatin in patients with ischemic heart disease and hyperlipoproteinemia]. / Izuchenie éffektivnosti gipolipidemicherskogo preparata lovastatina u bol'nykh ishemicheskoi bolezn'iu serdtsa i giperlipoproteidemiei.

Lovastatin was investigated in a single-blind placebo-controlled trial in 150 patients with coronary atherosclerosis confirmed by coronary angiographic studies and those with nonfamilial hyperlipoproteinemia. After 3 months of treatment total cholesterol (TC) level was reduced by 36% (p less than 0.001), LDL cholesterol level by 48% (p less than 0.001), triglycerides level by 19% (p less than 0.001), VLDL cholesterol by 24% (p less than 0.01), whereas the HDL-cholesterol level was increased by 36% (p less than 0.001). Besides, concentration of apolipoprotein A-I increased by 19% (p less than 0.05), apolipoprotein B decreased by 22% (p less than 0.05) and the ratios of LDL cholesterol/HDL cholesterol and TC/HDL cholesterol decreased by 64% and 56%, respectively (p less than 0.001). The side effects of lovastatin were negligible. Thus, lovastatin is a highly effective and well tolerated hypolipidemic drug for the treatment of patients with IHD and hyperlipoproteinemia.

[Mechanisms of the hypotensive action of captopril in essential hypertension]. / Mekhanizmy gipotenzivnogo deistviia kaptoprila pri gipertonicheskoi bolezni.

Captopril effects were studied in 27 patients with second-stage essential hypertension following administration of a single 25 mg oral dose of the drug. Blood pressure (BP), blood angiotensin-1-converting enzyme (ACE) activity, active (APR) and inactive (IPR) plasma renin levels were measured every 30 minutes for 3 hours. Before and near the end of the acute test, urinary kallikrein and catecholamine excretions were measured, and systemic and regional hemodynamic changes assessed. BP decreased in 21 patients: 11 of those had low basal APR (group 1), and 10 had normal or moderately elevated APR (group 2). The greatest hypotensive effect was observed within 1.5 hours after the administration, coinciding with the most marked ACE inhibition. There was no significant intergroup difference with respect to the extent of the hypotensive effect. No correlation was found between the hypotensive effect and the degree of ACE inhibition. All patients showed significantly decreased arteriolar tone, increased venous distensibility, decreased total peripheral resistance, and expanded end diastolic volume, while their cardiac output and heart rate remained unaffected. Hypertensive patients with low APR gave no evidence of renin-angiotensin inhibition or kallikrein-kinin activation that might have accounted for the hemodynamic effect of captopril.

[Use of captopril (capoten) in arterial hypertension]. / Primenenie kaptoprila (Kapotena) pri arterial'noi gipertonii.

Capoten (captopril) treatment was conducted in 39 patients with essential hypertension of stage IIA-IIB and in 4 patients with idiopathic hyperplasia of the adrenals. In 35 patients the hypotensive effect was evaluated following a single administration of captopril in a dose of 12.5, 25 and 50 mg. Twelve patients were treated with this drug alone while in 23 patients it was combined with saluretics. Captopril monotherapy elicited a good and moderate hypotensive effect in 70% of patients with a high and stable hypertension. Both mono- and combined therapy was associated with a decrease in adrenaline and noradrenaline excretion and an increase in uterine kallikrein excretion. The examination of the regional circulation revealed a significant reduction in the resistance and tonus of the arterioles and an enhancement of the blood flow in the forearm as well as an increase in venous tensility. When captopril was combined with diuretics these changes were less marked.