Possibilities of Detecting Pre-clinical Forms of Atherosclerosis During Periodic Preventive Inspections in Organized Collectives at Workers of Machine Building Enterprises

Aim. To study the structural and functional features of the carotid and femoral arteries using ultrasound duplex scanning of them in patients with hypertension undergoing periodic preventive medical examination.Material and methods. Periodic preventive examination was carried out for 2431 employees (1311 men and 1120 women) aged 20-65 years using a specially developed questionnaire, blood pressure measurement, anthropometry, total cholesterol test. Hypertensive men were assessed for preclinical manifestations of atherosclerosis by ultrasound duplex scanning of the carotid and femoral arteries.Results. Hypertensive men (BP ≥140/90 mmHg and/or taking antihypertensive drugs; n=176, mean age 43.5 years) were included in the study. An increase in the thickness of the intima-media complex in the carotid arteries was found in 22.2% (n=38) people, in the femoral arteries – in 34.1% (n=60) people, in both basins – in 16.5% (n= 29) man. Atherosclerotic plaques in the carotid arteries were found in 40.3% of people (n=71), and in the femoral arteries – in 34.7% (n=61) of people, in both pools – in 23.9% (n=42) of men.Conclusion. Ultrasound diagnostic using modern ultrasound scanners is a highly informative method for non-invasive diagnosis of atherosclerosis in the arteries of the carotid and femoral basins in employees of a large industrial enterprise with arterial hypertension in the conditions of the medical and sanitary department. Carrying out these diagnostic approaches is advisable when organizing periodic medical examinations in order to improve primary prevention, as well as to prevent the aggravation of the identified pathological process, reduce complications, improve quality and increase life expectancy

Aspirin for thromboembolic complication prevention in cardiovascular disease: dose optimization and adverse effect minimization

The review is devoted to acetylsalicylic acid (ASC) use in cardiology. Recent epidemiologic surveys demonstrated the important role of thrombosis as a factor provoking exacerbation of coronary heart disease, ischemic stroke, peripheral artery disease. Therefore, antithrombotic and antiplatelet therapy becomes most important in treating these diseases and in secondary prevention of vascular occlusion. Numerous studies proved that ASC therapy (75-325 mg/d) decreases risk of myocardial infarction, stroke, and cardiovascular mortality by approximately 25%. The review also contains the results of most reliable ACS trials, and comparison of ACS therapy with other antiplatelet regimens. An emphasis is put on ASC therapy safety. A relatively new medication, Cardiomagnyl, is described – a combination of ASC and non-absorbing antacid, Mg hydrate. This combination minimizes the risk of gastro-intestinal complications, including hemorrhage and perforation

ENDOTHELIAL DYSFUNCTION AND ROLE NITRATES AND BETA-BLOCKERS IN ITS CORRECTION IN ISCHEMIC HEART DISEASE

The role of endothelial dysfunction in the pathogenesis of ischemic heart disease and some other cardiovascular diseases is considered. The endothelial dysfunction takes place at the earliest stages of diseases. The interaction of vasodilator and vasoconstrictor factors produced by vascular endothelium is discussed. The treating effect of some medicinal products (nitrates, beta-blockers and others) is analyzed from the point of view of their correcting influence on endothelial function

Cardioselective beta-adrenoblocker bisoprolol in treating hypertensive patients with heart failure

The article is devoted to the role of modern beta-adrenoblockers (BB) in arterial hypertension (AH) treatment. Their indications include not only AH, but also coronary heart disease, heart failure (HF), and some cardiac arrhythmias. At present, it is widely accepted that BB are important in HF treatment: they decrease the negative effects of sympathic myocardial stimulation – myocardial overload, hypertrophy, fibrosis, and apoptosis. Beta-1 antagonist, bisoprolol, is a highly cardioselective agent. Therefore, it is often used in patients with AH and HF. This medication does not provoke hypoglycemia in diabetic individuals, or require oral anti-diabetic medication dosage correction. Concor® can be successfully combined with other medications, to effectively decrease cardiovascular morbidity and mortalit

Aggressive statin therapy in acute coronary syndrome: therapeutic potential of atorvastatin in the daily dose of 80 mg

The paper reviews recent studies justifying high-dose statin therapy (in particular, atorvastatin treatment) in patients with coronary heart disease (CHD) and high risk of life-threatening coronary events. In the latest placebo- controlled and comparative studies of high statin doses (e.g., 80 mg/d of atorvastatin) in stable CHD or acute coronary syndrome (ACS), a dose-depended effect of statins has been demonstrated, especially during the first months after ACS and myocardial infarction

Biochemical, structural and clinical analysis of statins’ pleiotropic effects

Based on the analysis of clinical and experimental studies, an attempt to explain pleiotropic effects of statins and their numerous action mechanisms has been performed. The pleiotropic effect concept includes: (a) medication effects on numerous targets, triggering various biochemical processes in the organism; b) the divergence of bio­chemical and pathophysiological processes triggered by one target. The pathochemical mechanisms of statins’ effects as HMG-CoA reductase inhibitors are explained. The authors also justify the independence of therapeutic and adverse effects of statins from their lipid and cholesterol-related mechanisms of action

REFRACTORY HYPERTENSION – MODERN APPROACHES TO DIAGNOSTICS AND TREATMENT

The refractory arterial hypertension (HT) is diagnosed, if therapy with three antihypertensive drugs from different classes (including a diuretic) in optimal doses did not provide target blood pressure (BP) level. Prevalence of a refractory HT is high and reaches up 10-30% among hypertensive patients. However, poor BP control is often caused by patient non-compliance with the medical recommendations, an inadequate estimation of BP level, and "white coat" HT. It is classified as a pseudo resistance. Obesity, salt and alcohol overconsumption, taking some drugs worsen BP control. Secondary HT causes (sleep apnea syndrome, kidney diseases, renal artery stenosis, and primary hyperaldosteronism) are more possible in patients with refractory HT. Specific treatment of these diseases improves BP control and long-term prognosis. Successful treatment of refractory HT includes detection and correction of reversible risk factors and reasons of the secondary HT, use of the effective combined therapy with the aldosterone antagonist. Improvement of patient compliance is one of key factors of effective treatment

Clinical, lipid-lowering, and pleiotropic effectiveness of rosuvastatin: a review of the GALAXY programme results

The paper reviews the results of the GALAXY international programme, a series of clinical (mostly comparative) studies of various statins. It has demonstrated the benefits of rosuvastatin in terms of normalization of lipid profile, inflammatory markers, and coronary or cerebrovascular atherosclerosis regression. This makes rosuvastatin medications promising for the prevention of severe organ complications at all atherosclerosis stages