Vol 21, No 5 (2019)


To the anniversary of academician Evgeny Ivanovich Chazov

- -.


10 июня 2019 г. академику Евгению Ивановичу Чазову исполнилось 90 лет. Евгений Иванович - человек, заложивший основы доказательной медицины, с его деятельностью связан настоящий прорыв в теоретической и практической кардиологии, он является вдохновителем и организатором высокоэффективной структуры специализированной помощи кардиологическим больным, создания лекарств и реабилитационных программ.
Consilium Medicum. 2019;21(5):9-10
pages 9-10 views

The clinical implication of the target organ protective properties of antihypertensive drugs in new guidelines for the management of arterial hypertension: the benefit of calcium channel blockers and diuretics

Kochetkov A.I., Ostroumova O.D.


Abstract It is well-known and proven that hypertension-mediated organ damage is about high clinical importance and prognostic significance as well as these end-organ structural and functional impairment are required to be reversed or delayed by antihypertensive treatment. Updated European and Russian guidelines for the management of arterial hypertension once again pay attention to the high prevalence of this disease. These documents also emphasize the priority of combination antihypertensive treatment, which includes, in addition to renin-angiotensin-aldosterone system blockers, calcium channel antagonists and diuretics, as a first-line therapy, indicated for the most patients with hypertension. The recommendations also highlight importance of target-organ damage as a factor contributing to an extremely increase in burden of cardiovascular risk for the patient and playing one of the fundamental prognostic roles in the development of fatal and non-fatal cardiovascular events. In this regard, it is reasonable to stress the powerful target-organ protective potential of the thiazide-like diuretic indapamide and the calcium channel blocker nitrendipine and their unique pharmacological properties, which favorably distinguish each of these antihypertensive drugs within their class and are provided the protection of all hypertension end-organs. The data from randomized clinical trials indicate not only the ability of indapamide and nitrendipine to prevent the development of target-organ damage, but also demonstrate their high potential in reversing such impairment caused by hypertension, which in turn suggests a reduction in cardiovascular risk and improved prognosis for patient during using of these drugs and expands the capabilities of physicians in target-organ protection with antihypertensive treatment.
Consilium Medicum. 2019;21(5):11-18
pages 11-18 views

Antihypertensive efficacy and adherence to treatment with the fixed-dose combination therapy in ambulatory patients aged 50-65 years with uncontrolled arterial hypertension

Larina V.N., Orlov D.A., Sviridova I.V.


Relevance. Arterial hypertension (AH) is one of the most common chronic diseases in the world and is the leading cause of serious complications on the part of many organs. To date, there are no clinical guidelines on the choice of drug therapy in men and women, which was the basis for conducting this study. Aim. To study the antihypertensive efficacy and adherence to treatment of the fixed combination of amlodipine/indapamide/perindopril in patients with uncontrolled hypertension at the age of 50-65 years. Materials and methods. Inclusion criteria: outpatient patients, age 50-65 years, AH 2-3 degree, not achieving the target values of blood pressure on a double antihypertensive combination. Initially and after 3 months of treatment, we collected complaints, anamnesis, determined anthropometric indicators, adherence to treatment and quality of life, ambulatory blood pressure monitoring (ABPM). Results. Against the background of 12-week therapy, there was a decrease in men with SBP from 171.8±8.1 to 132.7±8.3 mm Hg (p<0.001), DBP - from 101.9±5.1 to 81.1±3.7 mm Hg (p<0.001); in women, from 171.3±3.3 to 130.1±0.5 mm Hg (p<0.001) and from 100.5±1.6 to 80.3±1.1 (p<0.001), respectively. Target values of blood pressure achieved in all women and 94% of men. The use of a triple fixed combination of drugs contributed to the improvement of the day and night levels of SBP and DBP, blood pressure variability according to ABPM in both men (p<0.001) and in women (p<0.001). Improved adherence was noted in 31.2% of men (p=0.001) and in 45% of women (p<0.001). In women, this was facilitated by regular intake of the drug (p=0.001, r=0.88), in men, a dose of 5 mg + 1.25 mg + 4 mg (p=0.019, r=0.32) was taken. Increased adherence to treatment correlated with an improvement in the daily variability of DBP in both women (p=0.026, r=0.35) and in men (p=0.028, r=-0.31). Treatment with a triple fixed combination of drugs led to an improvement in indicators, covering almost all the components of the quality of life in women, and the physical component in men. Conclusion. The use of a fixed combination of amlodipine/indapamide/perindopril in patients with uncontrolled hypertension has high antihypertensive efficacy, allowing you to achieve target blood pressure levels during 12-week therapy in 100% of women and in 94% of men, increasing adherence to treatment with a satisfactory safety profile and metabolic neutrality, which allows us to consider this combination as a drug of choice for uncontrolled hypertension in both men and women.
Consilium Medicum. 2019;21(5):19-26
pages 19-26 views

Acetylsalicylic acid in the secondary prevention of cardiovascular complications

Kirichenko A.A., Ebzeeva E.I.


The development of symptoms of vascular disease significantly increases the risk of atherothrombotic complications. Despite the emergence of new antiplatelet drugs, for patients with cardiovascular diseases, acetylsalicylic acid (ASA) remains the basic antiplatelet agent. With secondary prophylaxis, the benefits of low (75-100 mg) and medium (150-325 mg) doses of ASA have been convincingly proven. A comparison of the antiplatelet efficacy of low doses of different forms of ASA showed that the enteric coating slows the release and absorption of ASA. Unlike conventional ASA, after the first dose of the enteric form, the degree of acetylation of cyclooxygenase-1 does not reach the maximum value. However, upon repeated daily intake, the acetylation of platelet cyclooxygenase cumulates and leads to a sufficient inhibition of its activity and inhibition of platelet function by the 6th day. The problem of prolonged use of ASA for the prevention of cardiovascular events is an increase in the frequency of gastrotoxic side effects and an increased risk of major bleeding. Most of the studies conducted did not reveal a significant reduction in the risk of bleeding from the upper gastrointestinal tract when using special forms of ASA. The main role in the development of the toxic effect of ASA on the mucous membrane of the upper gastrointestinal tract is assigned to systemic mechanisms.
Consilium Medicum. 2019;21(5):28-31
pages 28-31 views

Practical aspects of lipid-lowering therapy

- -.


Interview with the head of the clinomic laboratory at the National Medical Research Center for Preventive Medicine of the Ministry of Health of Russia, cardiologist, lipidologist, Candidate of Medical Sciences Alexandra I. Ershova
Consilium Medicum. 2019;21(5):33-37
pages 33-37 views

Achieving target lipid levels with statin and ezetimibe combination therapy

Shaposhnik I.I., Genkel V.V.


The article discusses the issues of achieving target lipid values when using different lipid-lowering therapy regimens. The use of a combination of low/medium doses of statins and ezetimibe acts through complementary mechanisms: a decrease in intracellular cholesterol concentration with increased capture of LDL-C by hepatocytes (statins) and a decrease in cholesterol absorption in the intestine (ezetimibe). This allows you to achieve a reduction in LDL cholesterol by 45-65%. In addition, combination therapy with statin and ezetimibe is safe and cost-effective. The combination of statin and ezetimibe makes it possible to more effectively achieve target lipid values in comparison with statin monotherapy. Thus, among patients taking a combination therapy, the achievement of target values of LDL cholesterol is observed in more than 70% of cases. The addition of ezetimibe to a statin is associated with an increase in the probability of reaching target LDL values 2.5-3.2 times. In accordance with current international recommendations, the prescription of ezetimibe is possible both in monotherapy mode (with statin intolerance) and as part of combination therapy. In the framework of combined lipid-lowering therapy, the administration of ezetimibe is recommended in addition to the statin (“on top”) in case of failure to achieve the target lipid values. Adding ezetimibe at a dose of 10 mg/day to statin therapy can be recommended in most patients at high and very high risk if target levels of LDL cholesterol are not achieved within 4-12 weeks after starting therapy. Generic product of ezetimibe - Otrio, tablets 10 mg (JSC “Akrikhin”, Russia) is bioequivalent to the original drug Ezetrol® 10 mg (“Schering-plough Labo N.V.”, Belgium). Usage of Otrio in combination with different statins will make combination therapy of hypercholesterolemia more accessible and will increase the frequency of achievement of target levels of lipids in patients with high and very high CV risk (including familial hypercholesterolemia, CRD and diabetes).
Consilium Medicum. 2019;21(5):38-42
pages 38-42 views

Clinical guidelines and expert opinion on the use of antiarrhythmic drugs in actual practice

Miller O.N., Syrov A.V., Doshchitsin V.L., Pavlova T.V., Tarasov A.V.


The article provides information only on antiarrhythmic drugs which are widely used in Russian clinical practice and include propafenone, amiodarone, sotalol and lappaconitine. There is a certain number of studies which investigated not only an efficacy but also a safety of each of these drugs. On the one hand, the treatment of arrhythmias in clinical practice has traditionally been considered a challenge because of the abundance of types of arrhythmias, and sometimes because of the aggressive action of antiarrhythmic drugs with the possibility of proarrhythmic and extracardiac complications. On the other hand, we often deal with a comorbid patient who has not only the evident structural disorder of the heart, but also comorbidity that should be considered when selecting the diagnostic algorithm and treatment regimen for a particular heart rhythm disorder. It is important to remember that a key point for a prescription of antiarrhythmic drugs should always be a balance between the efficacy and safety of the drug, since one must clearly realize the purpose of the treatment and take all precautions to avoid even more problems than those for which therapy is performed.
Consilium Medicum. 2019;21(5):43-50
pages 43-50 views

Complex approach to the treatment of patients with non-valvular atrial fibrillation. Place rivaroхaban

Morozova T.E., Konyshko N.A.


Atrial fibrillation (AF) is the most common heart rhythm disorder associated with aging. Diagnosis of AF requires documentation of the typical electrocardiogram pattern registration. Diagnosis of AF before complications is a recognized priority in the prevention of cardioembolic stroke. Non-valvular atrial fibrillation increases the risk of stroke by three to five times, especially in elderly patients, creating a significant load on the health care system, negatively affects the quality of life of patients. The basic principles of the supervision of patients with AF: emergency control of the frequency and/or rhythm to ensure stable hemodynamics and symptom relief; assessment and correction of factors contributing to the development, maintenance and recurrence of AF; assessment of the thromboembolic complications risk (stroke) and the anticoagulant therapy appointment. The use of oral anticoagulants is indicated in all patients with non-valvular AF, except for patients with low risk of stroke on the basis of the CHA2DS2-VASc scale or in the presence of absolute contraindications to anticoagulant therapy. Currently, there are research data illustrating the relative advantages of representatives of the new subclass of oral anticoagulants, for example, highly selective direct inhibitor of factor XA - rivaroxaban (Xarelto), which has a number of clinical and practical advantages over standard therapy in the treatment of elderly patients with non-valvular AF.
Consilium Medicum. 2019;21(5):51-56
pages 51-56 views

Ventricular arrhythmias in chronic heart failure: features of treatment and the possibility of improving the prognosis

Bunin Y.A., Zolozova E.A.


Ventricular arrhythmias often complicate the course of chronic heart failure (CHF) and are one of the main causes of sudden cardiac death (VSS). The article presents current data on the management of patients with CHF with "potentially dangerous" ventricular arrhythmias, drug and non-drug methods of primary prevention of VSS, including the use of implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy (CRT). An important place in the presented work is devoted to the treatment of stable VT and improvement of the prognosis for life-threatening ventricular arrhythmias (VT/VF): indications for use of class III antiarrhythmic, ICD and catheter ablation. It was noted that for patients with CHF who have sustained VT or who survived after circulatory arrest (VF), the optimal treatment is CD implantation, rather than pharmacotherapy. The presented material is based on data from modern international guidelines (ESC, AHA/ACC/HRS) for the treatment of CHF, ventricular arrhythmias and SCD prevention, as well as the results of a number of controlled studies and own clinical experience in the treatment of arrhythmias.
Consilium Medicum. 2019;21(5):57-61
pages 57-61 views

Drug-induced long QT interval: prevalence, risk factors, treatment and prevention

Ostroumova O.D., Goloborodova I.V.


Prolongation the QT interval is one of the most important problems in the scientific and practical medical communities. It is known that QT prolongation is a risk factor and a predictor of the life-threatening ventricular arrhythmias, including polymorphic ventricular tachycardia (torsade de pointes), capable of transformation into ventricular fibrillation with fatal outcome. Among the reasons contributing to the development of acquired prolongation the QT interval, the absolute leader is drug-induced prolongation the QT. Currently, most of the known groups of drugs have representatives that affect the duration of the QT interval: antipsychotics, antidepressants, antiarrhythmics, antibacterial, antifungal and anticancer drugs, diuretics (except potassium-sparing), ect. The development of clinically significant QT prolongation, including fatal outcomes, is promoted by certain risk factors, which include female gender, older age, hereditary conditionality, the presence of a structural heart disease, liver and/or kidney disease, as well as bradycardia, electrolyte abnormalities, drug interactions (use of simultaneously ≥2 QT-lengthening drugs, use of drugs with QT-lengthening action in combination with drugs that slow down their metabolism and/or violate and electrolyte metabolism, and/or impaired liver/kidney function), an overdose of QT-prolonged drugs. The main conditions for the prevention of drug-induced prolongation the QT interval are, on the one hand, the rejection of the use of drugs with this side effect, if it is impossible, the choice of the safest in the minimum effective dose. On the other hand, an important element of prevention is the monitoring and feasible correction of risk factors for prolongation the QT interval, with the third - ECG control. With the development of drug-induced prolongation the QT interval, immediate withdrawal of all suspicious drugs is necessary. The possibility of their return to the therapy should be considered only after the normalization the QT interval.
Consilium Medicum. 2019;21(5):62-67
pages 62-67 views

Modern aspects of diabetes mellitus type 2 treatment in cardiology practice (in the context of EASD/ADA consensus and Russian guidelines)

Evdokimova A.G., Golikova A.A., Striuk R.I., Lobanova E.G.


The article presents the importance of the problem of diagnostics and treatment of patients with diabetes mellitus (DM) type 2 in the light of steady increase of the prevalence of the disorder and its complications. Chronic hyperglycemia is a leading factor of cardiovascular disorders development associated with damage of eyes, kidneys, cardiac vessels, brain, and lower extremities arteries that results in disability and mortality of patients with DM type 2 and defines its social significance. The article provides definition of DM concept and classification, characterizes DM type 2 and other glycemic disorders diagnostic criteria. It is outlined that glycated hemoglobin (6.5% and more) is the diagnostic criterion for DM type 2. Special attention is given to glycemia self-control with the use of Contour™ Plus One glucometer, the distinguishing feature of which is the possibility of synchronization with mobile application Contour™ Diabetes. Therapeutic goals of DM type 2 treatment are defined according to ADA/EASD-2018 consensus (American Diabetes Association/ European Association for the Study of Diabetes) and Russian Association of Endocrinologists algorithms (2019). Recommendations for personalization of antihyperglycemic drugs choice in various clinical cases in consideration of rational drug combinations are given. Particular advantages of treatment using Russian guidelines are discussed.
Consilium Medicum. 2019;21(5):69-77
pages 69-77 views

Efficacy and safety of long-term use of prolonged bronchodilators in patients with cardiopulmonary pathology and chronic heart failure

Evdokimov V.V., Yushchuk E.N., Evdokimova A.G., Stryuk R.I.


The correction of the broncho-obstructive syndrome in patients with CHF of ischemic genesis in combination with chronic obstructive pulmonary disease (COPD) is an important problem in real clinical practice. Aim. The purpose of this study was to determine the safety and efficacy of long-term administration of tiotropium bromide and indacaterol as part of basic therapy of patients with CHF II-III FC and COPD of moderate and severe course. Materials and methods. The study included 2 stages: at the first stage of observation, 110 patients received basic therapy for CHF and COPD for 6 months; at the 2 nd stage (duration 6-18 months), 81 patients took part in the study, divided into 3 groups for receiving bronchodilator: 1st (29 people) received tiotropium bromide as part of complex therapy, 2nd (27 people) received indacaterol, and the 3rd (25 people) - a combination of tiotropium and indacaterol). At baseline and after 6-18 months, the clinical condition, the severity of CHF and COPD were assessed according to the quality of life questionnaires, exercise tolerance in the test with 6-minute walking, and the dynamics of echocardiography, BADM, and respiratory function. The comparison group consisted of 29 patients who retired after 6 months observations from the study. Results. Long-term use of tiotropium and indacaterol and their combination in the treatment of patients with CHF II-III FC in combination with COPD is effective and safe, improves the quality of life, reduces the number and duration of ischemia episodes, positive changes in intracardiac hemodynamics, stabilizes spirometry parameters and improves the prognosis
Consilium Medicum. 2019;21(5):78-83
pages 78-83 views

Cardiovascular disorders, quality of life, and compliance in the structure of neural network prognostic model of complications development in liver transplant recipients

Kosmacheva E.D., Babich A.E., Khalafian A.A., Akin'shina V.A.


Objective. To analyze cardiovascular disorders, lipid metabolism disorders, compliance level and quality of life of liver transplant recipients and to develop individualized approach to prediction of complications development with the use of artificial neural networks. Materials and methods. In the retrospective part of the study a database of primary documents of 135 patients (81 male, 54 female) who underwent orthotopic liver transplantation (OLT) in State Budgetary Healthcare Institution “Research institute - Prof. S.V. Ochapovskii Regional Clinical Hospital №1” in Krasnodar was developed. The present article analyses recipients cardiovascular status before and 4 years after liver transplantation as well as lipid and carbohydrate metabolism disorders at 6, 12, 24, 36, and 48 months with the use of Statistica 10.0 (Tibco, USA) software. In the prospective part questionnaire survey of the patients about compliance and quality of life was conducted. The designed recipients database was used for development of neural networks models in the program unit in Microsoft Visual C# 2015 software development environment for prognosis of complications development in liver transplant recipients according to combined endpoint - transplant hepatitis, thrombosis, tumors and episodes of transplant rejection. Results. Total cholesterol level was 3.6±1.6 mmol/L before transplantation, after 6 months, 12 months, 2, 3, and 4 years it increased by 16.7, 19.4, 27.8, 38.9 и 38.9%, respectively. Triglycerides level dynamics compared with baseline level before transplantation increased by 29.3, 41.7, 36.7, 52.2, 43.0% after 6 months, 1 year, 2 years, 3 years, and 4 years, respectively. Low density lipoprotein level before operation was 2.3±1.4 mmol/L and in 2 years increased by 8.7%, in 3 and 4 years by 21.7 и 26.1%, respectively. Before transplantation arterial hypertension was diagnosed in 21.5% of patients, the number increased to 29.6% during the observation period. Diabetes mellitus was diagnosed in 14.4% of patients before transplantation and in 22.7% of patients 4 years after it. Four years after liver transplantation the amount of patients with ischemic heart disease and chronic heart failure increased by 27.4 and 20.7%. Both in female and male liver transplant recipients low compliance to treatment was observed according to Morisky-Green questionnaire test. Most differences between recipients and healthy people were observed in “physical functioning” score - by 31.3%, “role functioning defined by physical functioning” - by 60.8%, “general state of health” - by 33.4%, “role functioning defined by emotional state” - by 52.9%. Characteristics of cardiovascular status of liver recipients, compliance and quality of life were included in artificial neural networks in program “Complication prognosis in liver recipients” with total predictive capability of the network accounted for 98.49%. Conclusion. In liver recipients frequency of cardiovascular disorders, diabetes mellitus and lipid metabolism disorders increased in comparison with pre-transplantation period. Study of compliance, quality of life and formed database of clinical, laboratory, and instrumental data on patients before transplantation and in 5 periods of time after it along with the use of neural networks allowed creating a program “Complication prognosis in liver recipients”, certificate of registration of computer program №2019614005.
Consilium Medicum. 2019;21(5):84-90
pages 84-90 views

The rate of symmetric complex anatomy of the arms’ arteries in the conversion from the right to the left radial approach, assessed by the data of the open registry COMPAAS (COMPlex Anatomy of Arteries and Symmetry)

Semitko S.P., Melnichenko I.S., Karpeeva M.I., Bolotov P.A., Analeev A.I., Azarov A.V., Kruk S.V., Klimov V.P., Sorokin V.V., Ioseliani D.G.


Background. Complex anatomy of the arms’ arteries is the most frequent cause of complications and failures occurring with transradial approach. Aim. To study the rate of symmetric complex arterial anatomy in both arms for the choice of an optimal and safe way of approach conversion in cases of right transradial approach failure. Material and methods. From January, 2018 to January, 2019, a total of 157 cases of complex arterial anatomy of the right arm were included in the registry: high origin of a. radialis (84); complete loop or tortuosity (66) and diffuse calcification of the arm’s arteries (7). The arterial anatomy of the left arm was studied with angiography. Results. The duplication of high bifurcation (with a. radialis arising from a. brachialis) in both arms was revealed in 20.9% (13/62); with a. radialis arising from a. axillaris, the symmetric arterial anatomy of both arms was half as frequent - in 9% (2/22). The symmetric marked tortuosity or complete loop in both arms was revealed in 54%, herewith in 25% of cases marked tortuosity was accompanied by the high origin of a. radialis. Bilateral total severe calcification of the arms’ arteries was seen in 85.7% of cases. Conclusion. In cases with total severe calcification or marked tortuosity of the high raised right a. radialis we recommend to perform the conversion to transfemoral approach because the rate of symmetry of such cases is high. In cases of the isolated high origin of the right a. radialis, the risk of facing similar problems with the left side is quite low and depend on level of a. radialis’s arising (7-20%).
Consilium Medicum. 2019;21(5):92-98
pages 92-98 views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies