Cause of Death and Predictors of All-Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation : Data From ROCKET AF

M. Kaste on työryhmän ROCKET AF Steering Comm jäsen.Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS(2) score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P= 75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, approximate to 7 in 10 deaths were cardiovascular, whereasPeer reviewe

COMBINED ANTIHYPERTENSIVE THERAPY IN METABOLIC SYNDROME

Aim. To compare effects of enalapril in combination with long-acting nifedipine or moxonidine on blood pressure (BP), myocardial mass and diastolic function of left ventricular, lipid and carbohydrate metabolism, platelet aggregation in patients with arterial hypertension (HT) and metabolic syndrome (MS).Material and methods. 50 patients with HT and MS were examined. 25 patients were treated with enalapril and long-acting nifedipine and 25 patients – with enalapril and moxonidine. 24-hour BP monitoring, echocardiography, anthropometry, lipid and carbohydrate metabolism estimation, platelet aggregation testing were performed before and 6 months after treatment.Results. Both combinations allowed to achieve target BP levels, provided cardioprotective and positive metabolic effects in most patients. The combination of enalapril and long-acting nifedipine had more significant antihypertensive effect and more prominently decreased the platelet aggregation induced by collagen. The combination of enalapril and moxonidine had more significant positive effects on carbohydrate metabolism and ADP-induced platelet aggregation.Conclusion. Enalapril in combination with long-acting nifedipine or moxonidine can be recommended for treatment of patients with HT and MS

ANTIHYPERTENSIVE EFFICACY OF VERAPAMIL PLUS INDAPAMIDE IN PATIENTS WITH METABOLIC SYNDROME

Aim. To study effect of combination of verapamil retard (Isoptinum SR) with indapamide retard (Arifon retard) on blood pressure (BP) level as well as lipid profile, glucose and electrolytes serum level in patients with metabolic syndrome (MS).Material and methods. 20 women of 35-65 y.o. with MS were examined. The combination of verapamil retard and indapamide retard were prescribed to patients during 24 weeks. Ambulatory BP monitoring (ABPM), lipide profile tests, electrolytes and glucose serum level tests were performed in all patients initially and after treatment.Results. Target systolic BP (SBP) was achieved in 90% of patients. Target diastolic BP (DBP) was achieved in 75% of patients. Drug combination effectively reduced SBP, DBP and pulse BP levels and improved other BP indices. This drug combination did not affect BP profile as well as glucose and electrolytes serum level, lipid profile.Conclusion. High antihypertensive efficacy and metabolic neutrality of verapamil retard and indapamide retard allows to use this combination in patients with MS

PSYCHOSOMATIC MEDICINE: A KEY TO EFFECTIVE REHABILITATION IN ONCOLOGY PATIENTS

Malignant tumors are still a challenging problem of contemporary medicine. The incidence of malignant diseases and patient mortality is increasing with time while there is no significant growth in long-term survival. Oncological diseases affect the quality of patient’s life more than any other medical conditions. In this regard, medical professionals are expected to pay a special attention to the psychosomatic aspects of patient management. It is important to realize that social and psychological maladaptation have a negative impact on the immune defense, which may trigger the onset or relapse of the major disease. Psychotherapy can improve the patient’s response to oncological treatment; the best way is to start using psychotherapy at the time of diagnosis. For the optimal effect, it is advisable to transfer the patients to specialized rehabilitation centers

INFLUENCE OF THE COMBINED ANTIHYPERTENSIVE THERAPY ON METABOLIC PROFILE AND CEREBRAL BLOOD FLOW IN PATIENTS WITH METABOLIC SYNDROME

Aim. To study influence of the combined antihypertensive therapy on blood pressure (BP), glucose and lipid metabolism as well as cerebral blood flow in patients with metabolic syndrome (МS)Material and methods. 60 patients with MS aged of 35-65 y.o. were included in the study. 29 patients of the 1st group received verapamil SR (240 mg once daily) and indapamide retard (1,5 mg once daily). 31 patients of the 2nd group received verapamil SR (240 mg once daily) and enalapril (12,2±5,9 mg BID). Ambulatory BP monitoring, lipid profile, insulin and C-peptide levels, standard glucose tolerance test were performed. The single-photon emission computer brain tomography was performed in 11 patients of each group.Results. Combination of verapamil SR and enalapril showed more significant antihypertensive effect, improved carbohydrate metabolism and cerebral blood flow. However it worsened 24-hour BP profile. Combination of verapamil SR and indapamide retard increased fasting glycemia level within normal range, led to insignificant improvement of cerebral blood flow and did not worsen circadian BP rhythm. Both drug combinations improved lipid profile.Conclusion. Both drug combinations can be prescribed to MS patients. However diuretic based therapy demands regular control of glycemia level

ENDOMETRIAL PRECANCER: DEFINITION OF CONCEPTS, TACTICS

Objective. To substantiate indications for a differential approach in the treatment of patients with atypical endometrial hyperplasia.Materials and Methods.The results of surgical treatment in 132 patients with atypical endometrial hyperplasia have been studied.Results. Post-operative diagnosis was:endometrial cancer – in 19%, atypical hyperplasia – in 35%, simple and complex hyperplasia – in 33%, only atrophic endometrial changes – in 13% of patients. The tumor was within the endometrium in 5 patients, the superficial invasion of the myometrium (1-2 mm) were in 8 patients, invasion to half of the myometrium – in 9 patients, invasion of more than half of the myometrium – in 3 patients.Conclusion. The guestions of tactics of treatment of atypical endometrial hyperplasia is under discussion

ENDOMETRIAL HYPERPLASIA: CONTROVERSIAL ISSUES OF PATHOGENESIS AND THERAPY

Traditional attitude towards the role of hyperestrogenia in endometrial hyperplasia pathogenesis can be considered cogent only in case of simple endometrial hyperplasia (SEH). In case of complex endometrial hyperplasia (CEH) and atypical endometrial hyperplasia (AEH) excessive proliferation occurs only in endometrial glands not diffusely but as pockets. The signs of atrophy are often registered outside these pockets that reflects the state of hypoestrogens. The aim. To justify a differentiated approach to treatment tactics of patients with EH. Material. Pathological changes adjacent to the lesions AEH in 274 patients have been studied. Results. The structure of the endometrium outside the foci of the CEH and the AEH represents a wide spectrum of pathological changes – SEH, proliferative and secretory endometrium, polyps, atrophic endometrium, that's not confirms the role of hyperestrogenic in the pathogenesis of the CEH and AEH. Conclusion. SEH, as a result of imbalance of estrogen and progesterone, is subject to cyclic hormone therapy with progestin for the prevention of acyclic bleeding. In the case of the absence of abnormal uterine bleeding after uterine curettage under SEH and CEH without atypia valid only observation with regular control. At AEH surgical treatment is required