Vol 20, No 1 (2018)

The negative impact of hyperaldosteronism in patients with congestive heart failure (CHF) is related not only to fluid retention but also to electrolyte imbalance. Aldosterone that can influence endothelium, vascular smooth muscle cells, and cardiomyocytes directly, induces fibrosis and hypertrophy that in turn promotes the diastolic dysfunction development and rhythm disturbance. Mineralocorticoid receptor (MCR) blockade is followed by left ventricular mass reduction that improves its contractile function and results in brain natriuretic peptide level reduction. EPHESUS and EMPHASIS-HF trials showed that adding MCR antagonists to ACE inhibitors and b-adrenoblockers additionally improves the clinical course and prognosis in patients with CHF. Early administration of eplerenone in patients with myocardial infarction with ST-segment elevation results in CHF development decrease. According to the latest guidelines on CHF treatment it is recommended to use threefold neurohormonal blockade - combination of renin-angiotensin-aldosterone system blockers (ACE inhibitors and angiotensin II receptor blockers) combined with b-adrenoblockers and MCR antagonists in patients with CHF after class II. This management regimen (including diuretics and cardiac glycoside prescription) improves not only patients’ quality of live but also disease prognosis. Spironolactone and eplerenone are considered equally effective. Though in clinical practice eplerenone an agent of choice because of its better tolerability and fewer side effects.

Recent decades have seen a growing recognition that the understanding of sex differences in cardiovascular disease is vital to optimal diagnosis and management, particularly of women. There is simultaneously an increasing appreciation of the multifactorial nature of ischemic heart disease (IHD) in many patients, in whom disease may extend beyond the epicardial coronaries. While obstructive coronary artery disease (CAD) remains underdiagnosed in women and still represents a major burden of disease, women also present with nonobstructive CAD more commonly than men. Indeed, microvascular dysfunction, coronary artery vasospasm, and coronary dissections contribute to a larger proportion of IHD in women than men. Here, we review the symptom presentation of women with IHD and the noninvasive modalities used to risk stratify women with suspected IHD.

The article concerns statin use in patients with diabetes mellitus for cardiovascular risk reduction in primary and secondary prevention. Data on target levels of low-density lipoprotein in various subgroups of patients with diabetes mellitus receiving therapy with statins is presented. Also results of randomized clinical trials and meta-analyses that indicate the increase of risk for new events of diabetes mellitus associated with statins use are discussed. The article also presents data on the prevalence of this adverse event, its dependence on the dosage and duration of statin use, and benefit-risk profile. The populations of patients with the highest risk for diabetes mellitus associated with statins use are listed.

The article presents a modern view on chronic obstructive pulmonary disease (COPD) and comorbid cardiovascular disease, the epidemiology is also discussed. The influence of comorbid disease on exacerbation development, prognosis and outcomes is demonstrated. Possible pathogenesis that contributes to high rate of comorbid cardiovascular disease development in patients with COPD and also to synergism in their development is presented. With regard to actual clinical guidelines the advances in COPD patients with comorbid cardiovascular disease management and treatment are discussed.

Atrial fibrillation is the most common arrhythmia in clinical practice. Number of patients with atrial fibrillation increases every year, primary due to the general aging of the population, as well as the presence of comorbidities. There are huge amount of research carried due to the search for optimal treatment and the most effective management of patients. In the given review the modern methods of the medicated sinus rhythm restoration and we analyzed updated recommendations of the Еuropean Society of Cardiology 2016 year.

The article covers similarities and differences of edema syndrome pathogenesis in congestive heart failure and hepatic cirrhosis as well as sites of action of different diuretics types. The regimen of salt restriction and such medications as spironolactone, eplerenone and acetazolamide are not widely used in everyday clinical practice. Compared with furosemide, torasemide is a more popular diuretic because of better pharmacodynamics profile and safety. Torasemide is a pharmacologic agent with anti-aldosterone and antihypertensive effects. It also has dose-related diuretic effect. When used in dosage of 2.5-5 mg it predominantly has antihypertensive and anti-aldosterone effects with weak natriuretic action that allows its use in everyday hypertension therapy. In medium dosage of 5-20 mg it is more often used in edema syndrome treatment whether in monotherapy or in combination with other diuretics except for loop diuretics. The anti-aldosterone mechanism is based on torasemide ability to block aldosterone receptors in kidneys and heart and lower aldosteron secretion in adrenal glands. It allows to slow down remodeling processes of heart muscle in patients with congestive heart failure and explains positive effects in edema of different genesis management.