Hyporesponse to statin therapy among patients with acute coronary syndrome: prevalence, impact on the development of heart failure in a short-term follow-up

Aim. To study the prevalence of hyporesponse to statin therapy and its impact on the development of heart failure (HF) among patients after acute coronary syndrome (ACS) in a short-term follow-up.Material and methods. This retrospective analysis of outpatient medical records of 400 patients observed at the Omsk Clinical Cardiology Dispensary after ACS was carried out. Optimal medication therapy was prescribed as part of the preferential provision of medicines under the 1H Program, including high-dose atorvastatin therapy (80 mg/day). Low-density lipoprotein cholesterol (LDL-C) was assessed at baseline and 1 and 12 months after therapy. Hyporesponse to statins was defined as the percentage reduction in LDL-C 14; left atrial volume index >34 ml/m2) function.Results. There were 107 patients with hyporesponse (26,8%). Depending on the initial response to therapy, patients were divided into two groups: group 1 (hyporesponse, n=107), group 2 (more pronounced response, n=293). After 1 month, patients in the hyporesponse group had a higher level of LDL-C — 2,4 [2,2; 2,9] mmol/l (Me [25; 75%]) vs 2,0 [1,7; 2,5] mmol/l (p>0,05) in the second group. There was no difference in the prevalence of hospitalizations for recurrent ACS in the compared groups, as well as in the prevalence of new HF cases between groups.Conclusion. The prevalence of hyporesponse to statin therapy was 26,8%, which required correction of lipid-lowering therapy in order to prevent recurrent cardiovascular events. Given the pleiotropic effects of statins that can participate in HF pathogenesis, as well as the inconsistency of current research results, further prospective long-term studies are required

Дисплазия соединительной ткани: пульмонологические аспект

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Behavioral risk factors and clinical course of cardiovascular diseases and other noncommunicable diseases during quarantine in various regions of Russia

Aim. To assess the behavioral risk factors and the clinical course of cardiovascular diseases (CVDs) and other noncommunicable diseases (NCDs) during quarantine in various regions of Russia.Material and methods. This multicenter cohort cross-sectional study included 205 men and women from 6 Russian cities. Further, 4 of them (Saransk, Nizhny Novgorod, Penza, Ulyanovsk) were combined into one group — the Volga region. The study included men and women aged 30-69 years with one or more NCDs (hypertension, coronary artery disease with or without myocardial infarction, type 2 diabetes, chronic obstructive pulmonary disease/asthma and cancer in patients receiving chemotherapy and/or radiation therapy) who were self-isolated during coronavirus disease 2019 (COVID-19) pandemic. For all patients, a questionnaire was used, which included socio-demographic parameters, behavioral risk factors, status of the underlying disease, incidence of COVID-19 and its complications. Self-assessment of the state of health was carried out using the European Quality of Life Questionnaire.Results. In every third Muscovite, the intensity of physical activity decreased, and in the groups of patients from Omsk and the Volga region, it was 45% and 43%, respectively. An increase in meal frequency and an impairment of eating habits in Moscow and Omsk was noted in 18,2% and 18,7% of participants, while in Volga region subjects, these parameters were 2 times higher (42,4%). At the same time, no significant changes of alcohol consumption and smoking was revealed in the cohorts. Hypertensive crises during a pandemic were noted in all three subgroups, but more of them were recorded in the Volga region — in every third patient (p< 0,05 compared to Moscow), in the Omsk group — in every fourth patient, and among Muscovites — no more than 5%. Clinical deterioration in patients with angina was noted in 15% of cases, while the smallest number was noted in Omsk subjects (5,3%), three times less than in other subgroups. Changes in intensity and regimen of hypoglycemic therapy were noted in patients from Omsk, while 30% of them (p< 0,05 compared with the Volga region) increased the doses of medications taken. Chronic obstructive pulmonary disease was registered in the group with the largest number of Volga region patients — 14,1% (p< 0,05 compared to Omsk), while 17% of patients in this group increased the dose of drugs. Any cancer was recorded in 13,6% of Muscovites, while in the other two groups — about 5%. The largest number of patients from the Volga region noted a health decline over the past year (30,8%), while every fifth patient from Omsk (19,6%) and 13,6% of Muscovites reported health changes.Conclusion. During quarantine and self-isolation, changes in dietary habits and physical activity decline were noted among patients with NCDs, while alcohol consumption and smoking remained practically unchanged. The change in clinical status was characterized by an increase in hypertensive crisis incidence, an increase in doses of antihypertensive and hypoglycemic medication. Depending on the region, the health decline was noted by 13-31% of patients with NCDs

Повторные пневмонии у детей с дисплазией соединительной ткани: ретроспективное клинико-морфологическое исследование

An analysis of medical documents and morphological examination of resected lung samples was done in 25 children had been operated for repeated pneumonias. All the children (100 %) were diagnosed undifferentiated connective tissue dysplasia (CTD) with marked clinical features. Morphological substrate of the repeated pneumonias was various defects of the lung growth. The results showed that the CTD as a genetic systemic pathology provided repeated pneumonias in structural abnormalities of the lungs. This fact should be taken into account in the diagnostic work-up.Проведен анализ медицинской документации и результатов морфологического исследования резецированных участков легких у 25 детей, оперированных по поводу повторных пневмоний. У 100% детей во время осмотра диагностирована недифференцированная дисплазия соединительной ткани (ДСТ) с выраженными клиническими проявлениями. Морфологическим субстратом повторных пневмоний явились различные варианты порочного развития легких. Результаты исследования свидетельствуют, что ДСТ как генетически детерминированный системный процесс предрасполагает к возникновению повторных пневмоний на фоне структурных аномалий легких, что необходимо учитывать в диагностическом процессе

Клинические аспекты включения пациентов с ишемической болезнью сердца после реваскуляризации миокарда в программу физической медицинской реабилитации на амбулаторном этапе

Aim. To determine the clinical factors affecting the timely reference of patients with coronary artery disease after myocardial revascularization to Phase 3 cardiac rehabilitation.Methods. 773 patients with coronary artery disease (CAD) who underwent myocardial revascularization were recruited in a study. Of them, 77 (9.96%) underwent coronary artery bypass grafting and 696 (90.04%) underwent PCI. Within 1 month of discharge, patients were examined by a cardiologist in the outpatient hospital and then referred to the cardiac rehabilitation team to assess their eligibility. The eligibility for exercise rehabilitation was assessed based on the results of general examination, clinical and laboratory findings. The prevalence of absolute and relative contraindications to exercise rehabilitation was measured.Results. 10% of CAD patients after myocardial revascularization had absolute contraindications and 29.6% had relative contraindications to exercise rehabilitation. The presence of relative contraindications (exaggerated blood pressure response (>80/100 mm Hg) to exercise or a decrease in systolic blood pressure ≥20 mm Hg, ventricular extrasystole and tachycardia, paroxysmal tachyarrhythmias in response to exercise, active gastroduodenal ulcer, and less than 1 month after its exacerbation, moderate heart valvular disease (aortic stenosis), decompensated carbohydrate metabolism disorders) required the management of risk factors limiting patients on the participation in exercise rehabilitation. The routing of CAD patients after myocardial revascularization at Phase 3 cardiac rehabilitation was developed and introduced in the Clinical Cardiological Dispensary in the Omsk region.Conclusion. Most patients with CAD after myocardial revascularization should be referred to exercise rehabilitation. These patients rarely have absolute contraindications (about 10%). Despite relative contraindications are rather high (about 30%), risk factors limiting patient participation in exercise rehabilitation are managed successfully. Optimal routing of patients contributes to their prompt recruiting to cardiac rehabilitation. Effective management of cardiovascular risk factors allows recruiting more patients in exercise rehabilitation.Цель. Определить клинические факторы, влияющие на своевременность включения пациентов с ишемической болезнью сердца (ИБС) после реваскуляризации миокарда в программу физической реабилитации (ПФР) с использованием тренажеров на третьем (амбулаторном) этапе медицинской реабилитации.Материалы и методы. В исследование методом сплошной выборки включены 773 пациента с ИБС после реваскуляризации миокарда: 77 (9,96%) больных, перенесших аортокоронарное шунтирование, и 696 (90,04%) - стентирование, обратившихся в первые трое суток после выписки из сосудистых центров к врачу-кардиологу БУЗОО «ККД», принятых для диспансерного наблюдения и направленных в течение месяца после перенесенного сердечно-сосудистого события к врачу-кардиологу - специалисту по медицинской реабилитации БУЗОО «ККД». На основании результатов общеклинического и клинико-лабораторного обследований определена распространенность абсолютных и относительных противопоказаний для включения пациентов в ПФР с использованием тренажеров. Оценка динамики эффективности физической реабилитации на тренажерах не являлась задачей настоящего исследования.Результаты. 10% пациентов с ИБС после реваскуляризации миокарда имели абсолютные, 29,6% - относительные противопоказания к участию в ПФР на тренажерах. Наличие относительных противопоказаний (повышение артериального давления в ответ на физическую нагрузку более 180/100 мм рт. ст. или снижение систолического артериального давления ≥20 мм рт. ст., желудочковая экстрасистолия и тахикардия опасных градаций, пароксизмальные тахиаритмии, язвенная болезнь желудка и двенадцатиперстной кишки в стадии обострения и ранее месяца после обострения, умеренно выраженный порок сердца (аортальный стеноз), декомпенсация нарушений углеводного обмена) потребовало коррекции факторов, ограничивших участие пациентов в ПФР. Разработана и внедрена в работу БУЗОО «ККД» маршрутизация пациентов с ИБС после реваскуляризации миокарда на третьем (амбулаторном) этапе медицинской реабилитации.Заключение. Большинство пациентов с ИБС после реваскуляризации миокарда должны быть включены в ПФР на тренажерах, так как абсолютные противопоказания встречаются достаточно редко (около 10%), а факторы, ограничивающие участие в физических тренировках (относительные противопоказания), несмотря на высокую распространенность (около 30%), могут быть скорректированы на этапе кардиореабилитации. Оптимальная маршрутизация пациентов определяет своевременность включения в ПФР. Коррекция факторов риска прогрессирования сердечно-сосудистых заболеваний способствует включению в ПФР наибольшего количества пациентов