EFFICACY AND SAFETY OF LIPID-LOWERING DRUGS IN PRIMARY AND SECONDARY PREVENTION OF CARDIOVASCULAR DISEASES IN THE ELDERLY

Effect of hyperlipidemia on morbidity and mortality in elderly patients is considered. Authors also cover issues of efficacy and safety of lipid-lowering therapy in primary and secondary prevention of cardiovascular diseases in patients ≥80 years of age who are the most quickly growing group of population and have the highest cardiovascular risk. They stress the need to take into account polymorbidity and polypharmacy that increase the risk of adverse reactions due to the use of both statins and their drug-drug interactions, which requires an assessment of risk/benefit ratio. In addition, there is a need for development of reliable prognostic tools to predict relevant outcomes (e.g., stroke, decrease in functionality/independence, quality of life reduction) and rationales for lipid-lowering therapy in the elderly and also their adherence to treatment

Features of pharmacotherapy in the elderly patients. Introduction to the problem

Features of pharmacotherapy in the elderly patients are discussed. Data on the pharmacokinetics and pharmacodynamics, comorbidity, polypragmasy and treatment adherence among patients of this age group are presented

Prevalence of geriatric syndromes in frail patients and mortality risks

The prevalence of older people in Russian population increases rapidly. Therefore, the concept of healthy aging is becoming crucial in Russia and all over the world, and thus disability prevention is one aspect of this issue.AimTo assess a possible association between geriatric syndromes, comorbidities, and mortality rate among frail patients who receive home medical care in Moscow.Materials and methodsThe study included 450 patients with home medical care provided by the State Budgetary Healthcare Institution “Diagnostic Center No. 3 of the Moscow Health Department” from June 2019 to April 2021. Physical health, functional, cognitive, social and emotional statuses were evaluated by comprehensive geriatric assessment (CGA). The mortality rate after 1 year was assessed.ResultsThe all-cause case mortality rate in patients during the observation period was 22.4%. There was no difference in age and comorbidities in survivors and deceased patients, but the latter group had more geriatric syndromes. The association between risks of mortality and anemia and some geriatric syndromes, such as malnutrition and hearing impairment, total dependence (Barthel index less than 60) was observed

Cognitive status in older patients with limited mobility as a predictor of negative outcome

Background. Cognitive impairment (CI) is one of the important disability factors in the elderly. The role of CI in prognosis of the frailest patients with limited mobility is uncertain.The aim. To determine the influence of the initial cognitive status in the group of patronage patients aged 60 years and older on the risk of mortality within one year.Materials and methods. Study group consisted of 450 patients from patronage group with one-year period of observation (from July 2019 till July 2020). Initial physical, functional, neuropsychiatriac and social statuses were evaluated by comprehensive geriatric assessment. Cognitive impairment was screened by Mini-Mental State Examination (MMSE), with dividing patients into dementia group (MMSE ≤ 24) and no-dementia group (MMSE > 24). The mortality rate after one year was assessed.Results. Of the 450 patients included in the study, dementia was present in 44.2 %. Patients with dementia were more prone to greater severity of chronic pain, sleep disturbances, depression, malnutrition and anemia. After one year of observation 34 out of 196 patients (17.3 %) in the group of patients with dementia and 18 out of 248 patients (7.3 %; p = 0.002) in the no-dementia group died. According to multivariate analysis, independent risk factors for death in patients with dementia were anemia, hearing impairment and a history of bone fractures.Conclusion. Thus, the assessment of the cognitive status of frail patients with limited mobility is important for the purpose of identifying the most vulnerable individuals with a high risk of adverse outcomes

Diagnosis and Treatment of Elderly and Senile Chronic Constipation: an Expert Consensus

Aim. An appraisal of practitioners with chronic constipation management details in older and senile adults.Key points. Chronic constipation is a common issue in geriatrics. Aside to age-related physiological bowel disfunction, a higher constipation incidence is conditioned by declined physical activity and frailty, polypharmacy and a series of secondary constipation-developing chronic states and diseases. Chronic constipation is associated with a higher risk of cardiovascular disease and complications, impaired general perception of health and pain, growing alarm and depression, and reduced quality of life. The treatment tactics in chronic constipation is cause-conditioned and should account for the patient’s history and therapy line, overall clinical condition, cognitive status and functional activity level. An essential baseline aspect of constipation management is apprising the patient and his family of the underlying factors and methods for non-drug and drug correction. An higher-fibre diet is recommended as first measure, with osmotic laxatives added and titrated to clinical response if none observed towards the non-drug and high-fibre regimens. Stimulant laxatives and prokinetics should be recommended in patients reluctant to fibre supplements and osmotic laxatives. Subsidiary correction includes biofeedback, transanal irrigation, acupuncture, foot reflexology and percutaneous tibial nerve stimulation.Conclusion. Elderly and senile chronic constipation is a prevalent multifactorial state requiring an efficient management via assessment and correction of total risk factors and consistent use of non-medication and drug therapies

Calcium antagonist nifedipine in treating pregnant women with arterial hypertension: pro and contra

Calcium antagonist nifedipine, an antihypertensive and anti-anginal medication with vasodilating action, is widely used in cardiology practice. According to the recommendations on cardiovascular disease management in pregnancy, by the European Society of Cardiology (2003) and Society of Cardiology of the Russian Federation (2003), nifedipine could be used for hypertension treatment in pregnancy. Positive experience of nifedipine use as an antihypertensive and tocolytic agent has been obtained. The medication has been proved as safe in III pregnancy trimester; its teratogenic and embryotoxic effects in the first pregnancy half have not been confirmed in clinical practice. Oral nifedipine effectively reduces increased blood pressure (BP) in hypertensive crises. Regular nifedipine therapy in pregnancy-associated hypertension facilitates effective BP control and prevents hypertensive crises

Nifedipine effects on blood cells and rheology in arterial hypertension and pregnancy

Arterial hypertension (AH) in pregnancy is associated with systemic endothelial damage, vasoconstriction, and blood rheology disturbances, that results in microcirculation disorders, tissue and organ ischemia. Antihypertensive therapy effects on endothelium and blood cells in hypertensive pregnant women should be taken into account. Recent experimental and clinical studies show that nifedipine has good antihypertensive effect in pregnancy, is safe, and beneficial for endothelium, platelets and red blood cells. Nifedipine non-hemodynamic effects support its use as a first-line medication in pregnancy-associated hypertensive states

Chronic arterial hypertension and its clinical course at various pregnancy stages (247hour blood pressure monitoring data)

Aim. То study circadian blood pressure (ВР) profile in chronic arterial hypertension (САП) at various pregnancy stages. Material and metliods. In total, 61 pregnant women with САH (mean age 27,9±0,8 years) were recruited in the main group. Control group included 50 normotensive pregnant women. All САH participants were followed-up since late first - early second pregnancy trimester Ambulatory 24-hour BP monitoring (BPM) was performed at various pregnancy stages, with standard parameter assessment. Results. In САH, circadian BP rhythm was unchanged, with increased 24-hour diastolic BP and decreased night time BP fall by early third trimester BP variability parameters in САH women were significantly higher than in normotensive women. Conclusion. 24-hour BPM in САH pregnant women is an important method for АH assessment at various pregnancy stages. Parameters obtained could be used for antihypertensive treatment initiation or correction, to prevent possible complications in this special patient group

Cardiovascular risk and the possibility of its correction in women with premature ovarian insufficiency

Since recently, the association of premature ovarian insufficiency (POI) with an increased risk of mortality and morbidity caused by cardiovascular diseases (CVD) has been extensively discussed in the context of early detection and prevention of CVD in these patients. Aim: to evaluate the relative cardiovascular risk (CV risk) before and after hormone replacement therapy (HRT) in women with POI. Materials and methods. The study included 170 women aged from 18 to 40; among them, 85 women with POI and 85 women with regular periods. We evaluated the usual CV risk factors: smoking habits, arterial blood pressure, total cholesterol (TC), low-density lipoproteins (LDL), high-density lipoproteins; in addition, we determined apolipoprotein B (Apo B), high-sensitivity C-reactive protein (hs-CRP), uric acid, and endotelin-1, as well as the functional markers: the right and left carotid intima-media thickness (CIMT) and the brachial artery flow-mediated dilatation (FMD). The CV risk was calculated using the relative risk SCORE scale before and after HRT lasted for 12 months. Results. In the POI group, there were 3.8 times more women with a moderate CV risk (per the SCORE scale), whereas in the POI-free group, women with a low CV risk dominated. In addition, the levels of CV risk markers were 4-fold higher in patients with POI (high levels of Apo B, hs-CRP and uric acid, increased CIMT bilaterally, decreased FMD in the brachial artery). Cyclic HRT during 12 months contributed to the lipid profile normalization, decrease in TC, LDL and FMD in the brachial artery as well as to the decrease of relative CV risk in general. Conclusion. The estrogen deficiency in patients with POI is an independent factor in the increased relative risk of CVD. The HRT has anti-atherogenic, antiinflammatory, and angioprotective effects, regulates the production of endothelium-dependent factors of vasoconstriction and vasodilation, leading to a reduction in the relative risk of CVD in general

Association of vascular stiffness and geriatric syndromes in hypertensive elderly patients

Aim. To study the relationship of vascular stiffness (cardio-ankle vascular index (CAVI)) with frailty and other geriatric syndromes in hypertensive elderly patients.Material and methods. The study included 160 patients aged 60 to 101 years with verified stage I-III hypertension. The previous therapy was assessed. A comprehensive geriatric assessment was performed with functional and neuropsychological tests to identify geriatric syndromes. Vascular stiffness was assessed by VaSera-VS-1500 vascular screening system (FUKUDA DENSHI, Japan) with determination of the CAVI.Results. The mean age of the patients was 77,2±8,1 years (n=160): in the group of patients without frailty — 72,4±6,9 years (n=50), with prefrailty — 76,6±8,1 years (n=50), with frailty — 81,7±6,6 (n=60). Patients with frailty had a higher CAVI than those without frailty and with prefrailty (10,3±1,6 vs 9,3±1,0 and 9,6±1,8, respectively; p=0,002).In patients with frailty, a negative correlation was found between the vascular stiffness and body mass index (BMI) (Rs=-0,392 (p=0,002)), and a positive correlation between the CAVI and orthostatic response (Rs=0,382 (p=0,003). In patients with prefrailty, negative relationships were found with the dynamometric parameters (Rs=-0,329 (p=0,019)), BMI (Rs=-0,343 (p=0,015) and physical activity (Rs=-0,285 (p=0,047)).In patients without frailty, the vascular stiffness was associated with an increased total cholesterol level (Rs=0,379 (p=0,009)), a low physical activity (Rs=-0,355 (p=0,015)), as well as negative correlations were found with the clock-drawing test and falls (Rs=-0,458 (p=0,011) and Rs=-0,306 (p=0,031), respectively).Conclusion. Vascular stiffness in elderly patients with frailty is associated with a decrease in body mass index and orthostatic hypotension. At the stage of prefrailty, the relationship between the vascular stiffness and muscle strength decrease (according to dynamometry) was revealed.Thus, the vascular stiffness is associated with frailty markers itself