Uric Acid as a Risk Factor for Cardiovascular Diseases

Recently, hyperuricemia and its association with cardiovascular disease have been receiving more and more attention. The article talks about the role of uric acid in the body, the reasons for its increase and the impact of elevated uric acid levels on the cardiovascular system. The mechanisms of influence of hyperuricemia on the development and progression of cardiovascular diseases are presented. Medicinal and non-drug ways to reduce the level of uric acid in the blood are considered. From non-drug methods, attention is focused on the hypopurine diet, adequate drinking regimen and normalization of body weight. Separately, the effect on the level of uric acid of various drugs used in clinical practice is considered. In the light of current clinical guidelines, the issue of the need to prescribe drug therapy for asymptomatic hyperuricemia is discussed

Hepcidin as a Regulator of Iron Metabolism and Mediator of Inflammation in Patients with Chronic Heart Failure and Anemia of Chronic Diseases of the Elderly and Senile Age

Aim. To study the role of hepcidin as a regulator of iron metabolism and a mediator of inflammation in elderly and senile patients with chronic heart failure (CHF) with anemia of chronic diseases (ACD).Material and methods. The levels of hemogram parameters, ferrokinetics (serum iron, ferritin, transferrin, erythropoietin, hepcidin), inflammation [C-reactive protein (CRP), interleukin-6 (IL-6)], as well as correlations between hepcidin and these parameters were studied in patients with CHF with ACD (n=35), with CHF without anemia (n=35) and in elderly and senile patients without CHF and anemia (control group; n=20).Results. Normal levels of hepcidin (9.17±0.97 ng/ml) and the only significant correlation of hepcidin with the ferrokinetic parameter – serum iron [r(S)=0.480, p<0.05] were found in the control group. Normal levels of hepcidin (12.01±1.19 ng/ml) and two significant correlations of hepcidin with the ferrokinetic parameter – ferritin [r(S)=0.525, p<0.05] and transferrin [r(S)=-0.343, p<0.05] were found in the CHF without anemia group. Significantly elevated levels of hepcidin (23.81±3.63 ng/ml) were found in the CHF with ACD group compared to the CHF without anemia group (p=0.008) and the control group (p=0.003). Also, five significant correlations of hepcidin with hemogram parameters – hemoglobin [r(S)=-0.461, p<0.05] and the average concentration of hemoglobin in the erythrocyte [r(S)=-0.437, p<0.05]; with ferrokinetic parameters – ferritin [r(S)=0.596,p<0.05] and transferrin [r(S)=-0.474, p<0.05]; with inflammation parameters – CRP [r(S)=0.561, p<0.05] were found in the CHF with ACD group.Conclusion. The increased level of hepcidin in CHF patients with ACD and the formation of links of hepcidin with indicators of inflammation reflect its role as a mediator of inflammation, and the formation of connections with indicators of hemogram and ferrokinetics – its role as a regulator of iron metabolism involved in the development of ACD in elderly and senile CHF patients

The Effect of Enhanced External Counterpulsation on the Vascular State, Indicators of Glycemic Control and Quality of Life in Patients with Coronary Artery Disease and Type 2 Diabetes Mellitus

Aim. To study the effect of enhanced external counterpulsation (EECP) on the functional status, quality of life, structural and functional state of the vascular bed, and markers of glycemic control in patients with coronary artery disease (CAD) and type 2 diabetes mellitus (DM).Material and methods. A pilot prospective randomized study included 30 patients with CAD and DM. Using a random number generator, patients were randomized into 2 groups: EECP (n=15) and a comparison group (n=15). All patients (n=30) received optimal medical therapy (OMT) during 3 months of follow-up. Patients in the EECP group underwent a course of EECP (35 hours, cuff pressure: 220-280 mmHg) during the first 7 weeks of the study. At baseline and after 3 months of follow-up, patients in both groups underwent an assessment of clinical status, quality of life (based on the SF-36 questionnaire), as well as a 6-minute walk test to assess exercise tolerance. The dynamics of fasting glucose, postprandial glucose, insulin resistance index (HOMA-IR) and glycated hemoglobin were assessed. Photoplethysmography and applanation tonometry were performed to assess the state of the vascular bed.Results. In the EECP group, after 3 months, there was a decrease in the frequency of angina attacks and an improvement in the functional class of angina according to the Canadian Cardiovascular Society (CCS) classification. A significant improvement in exercise tolerance was revealed [an increase in the 6-minute walking distance by 51 (35; 65) m, p<0.05], as well as an improvement in the physical and mental components of health according to the SF-36 questionnaire. A positive dynamics was shown in relation to the indicators of the state of both large vessels and the microvasculature (p>0.05), with the exception of the reflection index and the stiffness index (p<0.05). There was also a significant decrease in the HOMA-IR [-9.9% (-26.5; -4.0) vs 7.7% (-7.9; 13.8), p=0.004], as well as in the levels of fasting glucose [-10.5% (-15.8; -4.0) vs -2.7 (-8.3; 5.9), p=0.012] in the EECP group, compared with the OMT group.Conclusion. EECP course therapy in addition to OMT has a positive effect on the functional status and quality of life of patients with CAD and DM. After 3 months of observation, there was noted a positive dynamics of the vascular state, as well as markers of glycemic control, and these changes were more pronounced in the EECP group. The results obtained may indicate the effectiveness of EECP as an add-on treatment for this group of patients

LIPID-LOWERING THERAPY IN OUTPATIENT PRACTICE (ACCORDING TO THE ARGO-2 STUDY)

Aim. To study the features of lipid-lowering therapy with rosuvastatin in high and very high cardiovascular risk patients in real outpatient practice.Material and methods. Patients ≥30 years, visited internists or cardiologists of district outpatient clinics in the period from October 2013 to July 2014 were included into the study. Each patient fill in questionnaire. Determination of total cholesterol (TC) level was performed without special preparation of the patient using a portable photometric blood analyzer. Doctors prescribed rosuvastatin therapy when indicated, in accordance with the Guidelines, choosing the dose on their own. Repeated TC level was determined after 1 month.Results. TC level was initially determined in 10547 patients. Rosuvastatin treatment was recommended for all patients. Repeated TC level determination was performed in 7897 patients in an average after 33 days. Baseline TC level in them was 6.37±0.89 mmol/l, and after 1 month while taking rosuvastatin – 4.89±0.81 mmol/l (p<0.001). The change of TC level was -22% (p<0.001). The average prescribed dose of rosuvastatin was 11.88±5.1 mg per day. The most often (62.8%) rosuvastatin was prescribed in a dose of 10 mg per day, in 27.3% of patients – 20 mg per day, in 9.2% – 5 mg per day, and only 0.5% of patients took it in the maximal dose.Conclusion. In real clinical practice, rosuvastatin for treatment of patients with high or very high cardiovascular risk is often prescribed in moderate doses and rarely in the maximum dose despite the proven lipid-lowering effect

Inflammatory Activity in Patients with Obstructive and Non-obstructive Coronary Artery Disease

Aim. To study the levels of pro-inflammatory biomarkers  in patients with obstructive  and non-obstructive coronary  artery disease (CAD), to identify possible differences  for diagnosing the degree of coronary  obstruction.Material and methods. The observational  study included two groups of patients: with non-obstructive (main group,  coronary artery stenosis <50%; n=30) and obstructive  (comparison group,  hemodynamically significant  coronary  artery stenosis according to the results of coronary  angiography; n=30) CAD.  The levels of interleukin-1β (IL-1β) and interleukin 6 (IL-6) were measured in plasma using enzyme  immunoassay.Results. IL-6  levels were significantly higher in patients with obstructive  CAD  (p=0.006) than in patients with non-obstructive CAD.  There were no significant  differences  in the level of IL-1β in both groups  (p=0.482). When  constructing the ROC  curve,  the threshold  value of IL-6  was  26.060 pg/ml. At the level of IL-6  less than this value, CAD  was diagnosed with hemodynamically insignificant stenoses of the coronary  arteries.Conclusion. The results of this study confirm that in patients with different types of coronary  artery lesions, there are differences  in the activity of the inflammation process in the arterial wall. IL-6  was higher in the obstructive  lesion group,  and IL-1β levels did not differ between groups.  Thus, it can be assumed  that hemodynamically significant  obstruction  of the coronary  arteries develops  as a result of highly  active inflammation of the vascular wall. Given the presence of a proven biological  basis and the available data on the effectiveness of monoclonal antibodies to IL-1β, one cannot exclude their possible benefit in a cohort of patients with CAD  and hemodynamically insignificant stenoses

PROSPECTS FOR THE TREATMENT OF PATIENTS WITH ATRIAL FIBRILLATION

Basic principles of the management of patients with atrial fibrillation (AF) are discussed taking into account recommendations of the European Society of Cardiology (2010). Peculiarities of AF diagnosis, clinical course and severity estimation, approaches to complications prevention and therapy strategy choice in patients with AF (rhythm control or heart rate control) are presented

CARDIOLOGY: REALITY AND PROSPECTIVE. RESULTS OF RUSSIAN NATIONAL CONGRESS OF CARDIOLOGY

Cardiology: reality and prospective. Results of Russian National congress of cardiology

USING A COMBINATION OF PERINDOPRIL, INDAPAMIDE AND ROSUVASTATIN IN THE TREATMENT OF PATIENTS WITH HYPERTENSION AND DYSLIPIDEMIA

Aim. To study the antihypertensive and hypolipidemic effect of a group of drugs including perindopril,rosuvastatin and fixed-dose combination of perindopril and indapamide, in ambulatory patients with hypertension and dyslipidemia.Material and methods. Analysis of the medical data of patients treated with perindopril, indapamide and rosuvastatin in the multicenter, non-interventional study (SYNERGY) was performed. Patients had a diagnosis of hypertension and dyslipidemia, determined in routine clinical practice. Therapy was prescribed to patients in various dosing regimens. The data of anamnesis, physical status, blood pressure measurements, lipid levels were taken from the patient's medical records. The safety assessment was also performed. The duration of follow-up was 8 weeks.Results. A total of 1383 patients were included into the analysis, 53.5% (n=740) of women and 46.5% (n=643) of men. The average age was 55.8 years. 914 patients (66.1%) had previously received antihypertensive therapy, and 439 (31.7%) had previously received lipid-lowering therapy. A significant reduction in the levels of systolic (SBP), diastolic BP (DBP), and low-density lipoprotein cholesterol (LDL-c) was found at the end of the study in all study groups (p<0.05). This demonstrated an adequate antihypertensive and lipid-lowering effect of all treatment regimens. The mean decrease in SBP in treatment groups ranged from 14.3 to 36.2 mm Hg; the mean decrease in DBP – from 3.3 to 22.2 mm Hg. The maximum decrease in SBP was found in the group of perindopril + indapamide + rosuvastatin (PIR) 8 + 2.5 + 20 mg (36.2±12.3 mm Hg); the maximum decrease in DBP – in the group of perindopril + rosuvastatin 8 + 10 mg. The mean decrease in LDL-c level due to the combined treatment with perindopril, indapamide and rosuvastatin ranged from 0.62 mmol/L in PIR groups 2 + 0.625 + 5 mg and 8 + 2.5 + 5 mg to 1.78 mmol/L in PIR group 8 + 2.5 + 20 mg. Three of 1,383 patients reported adverse events after 4 weeks of treatment, while 13 patients – at the end of the study.Conclusion. PIR therapy resulted in a significant reduction in blood pressure in all treatment groups compared with baseline levels. A dose-dependent reduction in SBP and LDL-c levels was found in all treatment groups. The tolerability of all treatment regimens was good