Use of pharmacoinvasive approach to the treatment of patients with ST segment elevation acute coronary syndrome: state of the problem

Role of pharmacoinvasive tactics in the treatment of patients with ST-segment elevation acute myocardial infarction is considered. The expert opinions reflected in the final version of the guideline are given, as well as the results of clinical trials in which the efficacy of thrombolytic therapy at early stage after acute myocardial infarction onset comparedwith primary percutaneous coronary intervention. The place of pharmacoinvasive tactics in real clinical practice is discussed

Therapeutic Options for the Single Pill Combination of Lisinopril, Amlodipine and Rosuvastatin: a Systematic Review

Aim. To evaluate the effect of taking a single pill combination of amlodipine, lisinopril and rosuvastatin on blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) in hypertensive patients with or without severe hypercholesterolemia.Material and methods. Articles published in Russian were selected for analysis. Six articles that met the criteria for inclusion in a systematic review were found by searching the eLibrary database for the keyword "equamer". The results of 5 observational clinical studies were presented in these articles. The effectiveness of the fixed combination of amlodipine, lisinopril and rosuvastatin was assessed mainly by changes in the level of systolic and diastolic blood pressure, the concentration of LDL cholesterol. In addition, the effects of fixed-dose amlodipine, lisinopril, and rosuvastatin on central aortic pressure and its increment index, as well as carotid-femoral pulse wave velocity, were studied in part of the studies. The effect of the fixed combination of amlodipine, lisinopril and rosuvastatin on blood pressure and LDL-C concentration, as well as on these additional indicators, in patients who had a coronavirus infection with severe lung damage was studied in one study.Results. Evidence from a systematic review demonstrates the efficacy of single pill combination amlodipine, lisinopril and rosuvastatin in reducing blood pressure and LDL-C in a wide range of patients with different baseline risk of developing cardiovascular complications and different baseline levels of blood pressure and LDL-C.Conclusion. The data obtained confirm the feasibility of more frequent prescription of the single pill combination of amlodipine, lisinopril and rosuvastatin in clinical practice for the treatment of hypertensive patients with high or moderate risk of developing cardiovascular diseases, including patients with concomitant hypercholesterolemia

Анемия у больных с хронической сердечной недостаточностью: современное состояние проблемы

The article reports the modern tactics of treating patients with chronic heart failure and concomitant anemia. The results of the most important randomized clinical trials that are the basis for developing approaches to the treatment of anemia in such cases are discussed. Attention is also paid to unresolved problems in the treatment of anemia in patients with heart failure. The data on the intravenous administration of iron preparations as the most effective approach to the treatment of anemia in patients with heart failure in the presence of iron defciency are given. The main provisions of modern clinical guidelines on the management of patients with heart failure and anemia are considered.В статье рассмотрена современная тактика лечения больных с хронической сердечной недостаточностью и сопутствующей анемией. Обсуждаются результаты наиболее важных рандомизированных клинических исследований, которые стали основанием для разработки подходов к лечению анемии в таких случаях. Уделяется внимание и нерешенным проблемам лечения анемии у больных с сердечной недостаточностью (СН). Приводятся данные о внутривенном введении препаратов железа как наиболее эффективном подходе к лечению анемии у больных с сердечной недостаточностью при наличии дефицита железа. Рассматриваются основные положения современных клинических рекомендаций по тактике ведения больных с СН и анемией

Современные подходы к выбору лекарственной формы ацетилсалициловой кислоты в кардиологии

The article is devoted to modern approaches to the selection of optimal dosage forms of acetylsalicylic acid (ASA), which ensure high bioavailability of ASA drugs. The relevance of improving the tactics of ASA use for both primary and secondary prevention of cardiovascular diseases is discussed. Changes in the role of ASA in the prevention of cardiovascular disease complications are discussed, including as part of combined antithrombotic therapy, including ASA and either P2Y12 inhibitor or low-dose rivaroxaban. Evidence is presented that has led to doubts about the sufficient bioavailability of the enteric form of ASA, as well as the predictability of the response to therapy. A separate part of the article is devoted to the safety of different forms of ASA, in particular - the effect on the mucosa of the small intestine. The results of clinical studies evaluating the effect of ASA intake in enteric-soluble and buffered forms on the small intestinal mucosa and the risk of bleeding are presented. In addition, the problem of decreased effectiveness of ASA intake in overweight or obese individuals is considered. The article provides information on ongoing randomized trials to assess the effectiveness of increasing the frequency of ASA intake, as well as the effectiveness of chronopharmacological approaches to optimize the use of ASA. The analysis performed leads it to conclude that the buffer form can now be considered the preferred acetylsalicylic acid (ASA) dosage form, which, on the one hand, exerts a less pronounced effect on the gastric and small intestinal mucosa, and on the other hand, ensures high bioavailability, as well as minimal variability of treatment response.Статья посвящена современным подходам к выбору оптимальных лекарственных форм ацетилсалициловой кислоты (АСК), которые обеспечивают высокую биодоступность препаратов АСК. Рассматривается актуальность усовершенствования тактики применения АСК с целью как первичной, так и вторичной профилактики развития сердечно-сосудистых заболеваний. Обсуждается изменение роли АСК в профилактике развития осложнений сердечно-сосудистых заболеваний, в т. ч. в составе комбинированной антитромботической терапии, включающей АСК, а также либо ингибитор P2Y12, либо низкую дозу ривароксабана. Приводятся доказанные данные, которые стали основанием для сомнений в достаточной биодоступности кишечнорастворимой формы АСК, а также в предсказуемости ответной реакции на терапию. Отдельная часть статьи посвящена вопросам безопасности разных форм АСК, в частности – влиянию на слизистую оболочку тонкого кишечника. Приводятся результаты клинических исследований, в ходе выполнения которых оценивали влияние приема АСК в кишечнорастворимой и буферной форме на слизистую оболочку тонкого кишечника, а также риск развития кровотечений. Кроме того, рассматривается проблема снижения эффективности приема АСК у лиц с избыточной массой тела или ожирением. В статье предоставляется информация о продолжающихся рандомизированных исследованиях по оценке эффективности увеличения кратности приема АСК, а также по эффективности хронофармакологических подходов к оптимизации применения АСК. На основании выполненного анализа делается вывод о том, что в настоящее время предпочтительной лекарственной формой АСК можно считать буферную форму, которая, с одной стороны, обеспечивает менее выраженное влияние на слизистую оболочку желудка и тонкого кишечника, а с другой – обеспечивает высокую биодоступность, а также минимальную вариабельность ответной реакции на лечение

Modern strategy of treating patients with coronary artery disease: complementarity principle in therapy and new ideas about its role and components

The article discusses modern ideas about the role of mechanical revascularization and anti-ischemic  therapy  in the treatment of patients  with stable  coronary heart disease (CAD). Modern  data  on the  comparative  effectiveness  of anti-ischemic drugs  are  presented, which became the basis  for the development  of  “diamond approach”  in the treatment of stable CAD. It is proposed instead of standard tactics using a hierarchical approach to the choice of anti-ischemic drugs. The features  of the anti-ischemic  drugs use in certain clinical situations, in patients  with the most common comorbidities or complications  of CAD, as well as in CAD variants, in the development  of which specific pathophysiological elements  play a role, are considered

ROLE OF POWERFUL STATINS IN MODERN TREATMENT OF PATIENTS WITH A HIGH RISK OF COMPLICATIONS ARISING FROM ATHEROSCLEROSIS

The article discusses modern approaches to the treatment of atherogenic patients, provides data on the effectiveness of new hypolipidemic drugs and discusses the role of intensive statin use regimes at the modern stage of the lipid-lowering therapy. Evidence is provided on the effectiveness of the use of rosuvastatin to reduce blodo LDL-cholesterol and to reduce the risk of cardiovascular disease complications caused by atherosclerosis

INTEGRATION OF BIOMARKERS INTO THE PRACTICE OF TREATING PATIENTS WITH HEART FAILURE: THE ROLE OF DETERMINING THE BLOOD LEVEL OF NATRIURETIC PEPTIDES

A clinical role of biomarkers (especially, natriuretic peptides) is discussed in the article. The most important evidences of clinical effectiveness of using biomarkers in patients with suspected heart failure and in patients with confirmed diagnose of heart failure are reviewed. The need to use natriuretic peptides in patients with takotsubo syndrome is discussed. Limited diagnostic value of using natriuretic peptides in renal dysfunction, as well as in other diseases in which the concentration of natriuretic peptides may increase in the absence of heart failure, is also discussed

THERAPEUTIC EFFECT ON HEART RATE: VISIBLE SIMPLICITY AND REAL DIFFICULTY

The article provides discussion of the clinical importance of the increased heart rate in healthy persons and in cardiovascular disease affected patients. Results of large randomized studies devoted to evaluation of ivabradine effect evaluation in patients with coronary heart disease and chronic cardiac insufficiency, as well as study results. Results of analysis evidencing positive effect of heart rate reduction due to ivabradine use on the left ventricle remodeling are discussed. Data are provided that might confirm justification of the early addition of ivabradine to β-adrenergic blocking agents at the stationary stage of the patients therapy who were hospitalized due to cardiac insufficiency aggravation

INNOVATIVE TECHNOLOGIES IN CARDIOLOGY: FROM SURPRISE TO HABIT OR FORGETFULNESS

Change of the status of innovative technologies depending on the received evidences is considered. Examples reflecting the initiation of interest in the new technology of treatment, the transition from innovation to standard therapies, as well as the weakening of interest in the previously introduced technology due to disappointing results of clinical trials on evaluation of its effectiveness are presented.</p

Anemia in Patients with Heart Failure: Current State of the Problem

The article reports the modern tactics of treating patients with chronic heart failure and concomitant anemia. The results of the most important randomized clinical trials that are the basis for developing approaches to the treatment of anemia in such cases are discussed. Attention is also paid to unresolved problems in the treatment of anemia in patients with heart failure. The data on the intravenous administration of iron preparations as the most effective approach to the treatment of anemia in patients with heart failure in the presence of iron defciency are given. The main provisions of modern clinical guidelines on the management of patients with heart failure and anemia are considered