Vol 20, No 5 (2018)


Asthma and cardiovascular disease

Ostroumova O.D., Goloborodova I.V., Voevodina N.Y., Fomina V.M., Seregin A.A.


The problem of comorbidity is becoming one of the most important problems in modern medicine. Asthma and cardiovascular disease co-existence is one of the most typical combinations in the overall structure of comorbidity. The article encompasses and discusses the present knowledge on incidence, structure and charachteristics of asthma and several cardiovascular diseases from the point of view of interaction and mutual severity increase as well as existing challenges and perspectives in diagnostics and treatment of above-mentioned conditions.
Consilium Medicum. 2018;20(5):8-16
pages 8-16 views

Anti-inflammatory therapy in atherosclerosis - is it a new promising trend?

Kirichenko A.A.


Elevated level of inflammatory markers in blood is an independent prognostic factor for cardiovascular events in patients with stable or asymptomatic IHD. Local inflammation activation in atheromatous plaque results in fibrous capsule destruction and risk of its rupture with arterial thrombosis formation. Viruses and bacteriophages can be inductors for inflammatory response. Synergistic action of several pathogens increases risk of inflammatory process development in vessel wall that is reflected in “infection burden” conception. Immunoinflammatory rheumatic disorders are characterized by high risk of cardiovascular events development. Chronic inflammation as a core aspect of atherosclerosis pathogenesis can be explained not only by infectious and immune, but also by metabolic factors. Macrophage inflammasomes activation induced with cholesterol crystals is an important link between cholesterol metabolism and atheromatous plaque inflammation. Reduction of cardiovascular events risk on the background of anti-inflammatory therapy confirms the important pathogenic role of inflammation. It is also supported by CANTOS trial results acquired in 2017: secondary cardiovascular events prophylaxis with human monoclonal antibodies to interleukin 1β (canakinumab) in patients with stable IHD in whom an increase of hsCRP (more than 2 mg/l) was found resulted in significant cardiovascular risk reduction irrespective of sex, smoking and serum lipid level.
Consilium Medicum. 2018;20(5):18-22
pages 18-22 views

Dyslipidemia and atherosclerosis in type 2 diabetes mellitus patients. Statin therapy characteristics and comparative analysis: endocrinologist’s point of view

Demidova T.Y., Susareva O.V.


Patients with type 2 diabetes mellitus (DM type 2) are in a high-risk group of cardiovascular disease (CVD) development, and coexisting DM type 2 and CVD contribute to high mortality risk. Statin use in DM type 2 patients for CVD prevention is one of the key concepts of modern antidiabetic therapy. It is statins which are considered as first line hypolipidemic therapy in DM type 2 patients according to international guidelines and DM treatment algorithm of Russian Diabetes Association. Target lipid profile values achievement is one of the major tasks in statin therapy. It was shown in multicenter randomized blind placebo-controlled clinical trials that patients who received rosuvastatin had the best results in cholesterol, triglycerides, LDL, and C-reactive protein level reduction. Rosuvastatin has a dose-dependent effect and can be recommended as treatment of choice
Consilium Medicum. 2018;20(5):24-28
pages 24-28 views

Electrocardiographic predictors of sudden cardiac death

Nikiforov V.S., Metso K.V.


The article deals with electrocardiographic predictors of sudden cardiac death. The authors pay attention to ventricular arrhythmias, analysis of heart rate, variability and turbulence of rhythm, electrocardiographic criteria of ischemia and myocardial hypertrophy. The role of the analysis of the microwave alternation of the wave T, ventricular late potentials and QT interval is shown. The importance of an integrated approach in stratifying the risk of sudden cardiac death and the need for further multicenter studies are noted
Consilium Medicum. 2018;20(5):29-33
pages 29-33 views

Atrial fibrillation in hypertrophic cardiomyopathy: modern aspects of epidemiology, risk factors, pathogenesis and medication-assisted treatment

Streltsova A.A., Gudkova A.Y., Kostareva A.A.


Atrial fibrillation (AF) is a particularly important arrhythmia in hypertrophic cardiomyopathy (HCM). This article describes the epidemiology of AF within the HCM population and analyses risk factors for the development of AF. The possible relation between the development of atrial fibrillation (AF) and insulin resistance in patients with HCM is also discussed. Here, we also review the outcomes associated with AF in HCM population and pharmacologic treatment strategies in this patient group
Consilium Medicum. 2018;20(5):34-39
pages 34-39 views

Transcatheter sympathetic renal denervation for resistant arterial hypertension: the current state

Bolotov P.A., Semitko S.P., Klimov V.P., Vertkina N.V.


Arterial hypertension is a main independent predictor of cardiovascular morbidity and mortality. Despite recent achievements of antihypertensive therapy, the incidence rate of suboptimal blood pressure control remains high. According to large trials, the prevalence of resistant hypertension is 6-12% among hypertensive patients. Renal sympathetic denervation (RSD) is being considered as a new frontier in the overcoming of drug resistance. The current article reviews recent view of pathophysiology of resistant hypertension and the role of sympathetic nervous system and modern technological developments of RSD. The results of major clinical trials are being discussed in order to reexamine the feasibility and efficacy of RSD to treat hypertension. An extensive post hoc analysis of Symplicity HTN-3 and intermediate results of new ongoing trials predict that RDN will emerge as an effective therapy for the treatment of hypertension and other clinical conditions associated with chronically elevated sympathetic activity
Consilium Medicum. 2018;20(5):40-49
pages 40-49 views

Treatment of chronic heart failure and arterial hypertension: two aims and one drug - fosinopril

Trukhan D.I.


The current problem of public health is the optimization of drug therapy in patients with arterial hypertension and chronic heart failure. The review examines the results of foreign and Russian studies, which indicate that fosinopril is a drug with proven efficacy in the treatment of patients with аrterial hypertension and chronic heart failure. The double elimination route does not allow the drug to be cumulated in the body, which makes fosinopril the drug of choice in patients with concomitant liver or kidney pathology, diabetes mellitus, and elderly people
Consilium Medicum. 2018;20(5):50-55
pages 50-55 views

A new and exclusive fixed combination of b-adrenoblocker and angiotensin-converting-enzyme inhibitor: two components and three indications for Prestilol use

Kosmacheva E.D., Kompaniets O.G., Zubareva N.A.


Treatment compliance is one of the most important factors that guarantee the therapy quality and have a direct impact on prognosis in chronic patients. Fixed dose combinations significantly increase compliance that is especially important in life-saving drugs use. New medication Prestilol is the first fixed combination of b-adrenoblocker bisoprolol and angiotensin-converting-enzyme inhibitor perindopril. The article shows effectiveness of Prestilol active ingredients both in clinical symptoms reduction and in cardiovascular events frequency and mortality decrease. Unlike most of antihypertensive drugs fixed combinations including combinations with bisoprolol or perindopril, amongst indications for Prestilol use are not only hypertension but also stable ischemic heart disease and congestive heart failure with decreased left ventricle function
Consilium Medicum. 2018;20(5):56-60
pages 56-60 views

The implementation of cardioprotection with nicorandil from periprocedural damage during elective percutaneous coronary interventions in patients with stable coronary heart disease

Gostishchev R.V., Soboleva G.N., Samko A.N., Minasyan A.A.


The purpose of the study is to demonstrate such an effect of the nicorandil like the pharmacological preconditioning in patients with stable coronary heart disease (CHD) during elective percutaneous coronary intervention (PCI). Material and methods. The study included 88 patients with a stable form of CHD directed to the elective PCI. By the method of blind randomization (envelope method) two groups or patients were formed: 45 patients in the first group (main group) - for treatment with nicorandil (Cordinic, PIQ-FHARMA LLC) and 43 patients in the second group for standard therapy (comparison group). In both groups the basic antianginal therapy was allowed - b-blockers, calcium antagonists, ATE inhibitors/angiotensin II receptor blockers, statins, acetylsalicylic acid, blockers of P2Y12 receptor platelets. In the second group was allowed the admission of prolonged form of nitrates before PCI. Patients of the 1st group took nicorandil 2 days prior to PCI at a dose of 30 mg/day, 2 hours before PCI - 20 mg orally, after 6 hours after PCI - 10 mg nicorandil. Highly sensitive troponin (HS-Tn) as a biomarker of irreversible damage to the myocardium was evaluated before PCI and after PCI in 24 hours. Results. The obtained data shows the significant increase in HS-Tn in 24 hours after PCI in patients with no admission of nicorandil (117 ng/l) as compared with the nicorandil group (73 ng/l), p=0.04. There were significant differences in the 24 hours increment in HS-Tn in the control group, it was higher (112 ng/l) than in the nicorandil group (67 ng/l), p=0.03. Also the frequency of the troponin increase above the upper normal level in the nicorandal group, was significantly (p=0.03) lower (in 62% of cases compared to 85% of the control group). The conclusion. The protective effect of the oral form of nicorandil admission on the reduction of damage to cardiomyocytes during the elective PCI is a clinically proven effect of pharmacological preconditioning of this drug, which will expand the indications for its purpose in the strategy of drug support of PCI in patients with stable CHD.
Consilium Medicum. 2018;20(5):61-65
pages 61-65 views

Traditional lifestyle change as a reason for metabolic disorders risk increase in residents of Gornaya Shoriya

Cygankova D.P., Mulerova T.A., Ogarkov M.Y., Saarela E.Y., Barbarash O.L.


Actuality. Abdominal obesity, hypertension, carbohydrate and lipid metabolism disturbance are the major components of metabolic syndrome (MS) and important risk factors for cardiovascular disease development. Lifestyle and living conditions play a significant part in MS components prevalence. Aim. To estimate prevalence of MS and carbohydrate metabolism disturbance in native and non-indigenous population of Mountain Shoria. Materials and methods. We assessed 718 people: the first group included native population (shorians) - 403 people, the second group - non-indigenous population - 315 people. All patients were divided into groups according to sex, ethnicity and age. MS was diagnosed according to International Diabetes Federation criteria. Statistical analysis was performed with Statistica 10.0 application software programs. The significance value was less than 0.05. Results. MS was diagnosed in 40.2% if inhabitants. Among native population it was found in 12.4%, in non-indigenous population - in 47.8% (р=0.00001). In native female inhabitants MS was found in 36.8%, in non-indigenous female inhabitants - in 60.7% cases (р=0.00002). Impaired fasting glycemia (IFG) was found in 11.4% native female inhabitants and in 22.6% non-indigenous female inhabitants (р=0.0004). Impaired glucose tolerance (IGT) was found in 7.6% female shorians and in 10.7% female non-shorians (р=0.204). New onset diabetes mellitus (DM) was found in 6.5% female shorians and in 8.7% female non-shorians (р=0.326), in total DM was found in 12.1%, native female inhabitants and in 16.9% non-indigenous female inhabitants (р=0.113). IFG was found in 14.7% of male shorians and in 26.7% male non-shorians (р=0.027). IGT was found in 5.1% of native male inhabitants and in 7.0% non-indigenous male inhabitants (р=0.785). New onset DM accounted for 5.0% in shorians and 2.3% in non-shorians (р=0.299), in total DM was found in в 5.9 and 7.0%, respectively (р=0.965). Conclusions. MS is more frequent in non-indigenous population than in native population. Carbohydrate metabolism disturbance (IFG, IGT, DM) was less frequent in shorians than in non-shorians mostly because of increased prevalence of IFG in non-indigenous population, irrespective of gender. A discovered negative trend in MS and carbohydrate metabolism disturbance prevalence increase that is associated with native population lifestyle change requires more active awareness education and medical interventions such as glycemia self-control
Consilium Medicum. 2018;20(5):66-70
pages 66-70 views

A clinical case of multiple amiodarone side effects development

Sivyakova O.N., Shmanova N.Y., Duleba A.P.


The aim of the study was to present a clinical case of multiple amiodarone side effects development in a female patient after a long-term uncontrolled medication use and to demonstrate the case management. Special aspects of the clinical case. The patient was uncontrollably using amiodarone for 6 years in the total dose about 1500 g as she feared atrial fibrillation paroxysms development. After 2 years of treatment bradicardia and grey and purple skin tone developed, the patient concealed it with make-up, in 1 more year hand tremor appeared. In the next 2 years dry cough and dyspnea developed that forced the patient to seek medical advice. After medical assessment “amiodarone lung” was diagnosed, amoidarone withdrawal and a visit to cardiologist were recommended, but the patient persisted in amoidarone use. Cough and dyspnea intensified, dyspeptic, neurologic, and vision disorders developed. The patient sought medical assistance only when she became non-ambulant. After amoidarone withdrawal regression of most of the side effects was observed. Amoidarone withdrawal was possible only after alternative anti-arrhythmic therapy was adjusted. Conclusion. To avoid cases of multiple drug side effects development a complex approach to patients and the Ministry of Health of the Russian Federation warrant №403n from 11.07.2017 “On the approval of medication dispending order...” implementation are required
Consilium Medicum. 2018;20(5):71-74
pages 71-74 views

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