Vol 26, No 10 (2024): CARDIOLOGY AND NEPHROLOGY

Statins have been used in clinical practice for more than 40 years to treat and prevent atherosclerosis and its complications. The results of observational studies indicate that, despite a large evidence base, statins in Russia are still prescribed in low doses, for a maximum of 6 months, leading to a low percentage of achieving the target levels of low-density lipoprotein cholesterol and, thus, to a high residual risk of cardiovascular complications. This paper presents a literature review and analysis of the basic principles of statin therapy in primary prevention, intensive lipid-lowering therapy in patients with very high cardiovascular risk, as well as key safety updates on cholesterol decrease for various organs and systems (liver, kidneys, muscles, nervous system), and carbohydrate metabolism. The article also provides a brief overview of new international guidelines to optimize the diagnosis and treatment of dyslipidemias, which can be useful in the day-to-day practice of an internal medicine specialist.

Despite the emergence and active development of interventional methods for the treatment of arrhythmias, to date, the use of antiarrhythmic drugs to recover and maintain sinus rhythm is the most significant and in demand in patients with paroxysmal and persistent forms of atrial fibrillation (AF). The results of multicenter randomized clinical studies show that early antiarrhythmic therapy to recover and maintain sinus rhythm improves the prognosis for patients with AF. Currently, the most effective and safe drugs to control AF paroxysms and maintain sinus rhythm are class 1C and III agents, according to the Vaughan–Williams classification. The development of new antiarrhythmic drugs brings hope for the emergence of an effective and safe means for the control and prevention of AF, which will significantly improve the quality of life of patients and their prognosis.

Cardiovascular diseases (CVD) are a global medical, social and economic problem. Currently, the search and study of new biological markers that can provide early diagnosis of CVD, serve as a laboratory tool for evaluating the effectiveness of treatment or be used as prognostic markers and criteria for risk stratification continues. The interest of scientists is focused on the study of the type 1 lectin-like receptor for oxidized low-density lipoproteins (LOX-1) as a diagnostic and prognostic marker in CVD. The presented literature review highlights the potential significance of the LOX-1 study as a diagnostic and prognostic laboratory tool in CVD. It is expected that future clinical and experimental studies will confirm the possibility of using LOX-1 as an additional non-invasive tool for diagnosis and prognosis assessment in patients with CVD. Modulation of LOX-1 levels and expression using pharmacological drugs may prove to be a promising direction for the treatment of CVD.

Aim. To evaluate treatment adherence among patients with gout.

Materials and methods. One hundred and thirty-eight patients with gout were examined in the Dzhanelidze Saint Petersburg Research Institute of Emergency Care; 89.9% of them are men and 10.1% are women. The average age of the subjects was 58.1±1.1 years, the average duration of the disease was 8.4±0.7 years. All patients answered a questionnaire in which they indicated the prescription of the disease, the number of gout attacks over the past 12 months, adherence to a low-purine diet, taking urate-lowering drugs, dose and duration of therapy, as well as contacting a rheumatologist and the regularity of observation by a specialist. All the subjects were also examined to identify tofuses, and blood was taken from them to determine the level of uric acid. Results were statistically processed, considering the differences as significant at p<0.05.

Results. Tophi were detected in 31.9% of patients. The average uric acid level in all examined patients was 8.1±0.2 mg/dl, while the target level of less than 6.0 mg/dl was detected only in 10.1%. Of all the respondents, only 13.0% of patients had no arthritis attacks in the last 12 months, the remaining 87.0% of patients had at least one attack during this period; 36.2% of people had never taken urate-lowering therapy; 39.1% of patients regularly received urate-lowering drugs, most of them (20.3%) took allopurinol at a dose of 100 mg/day, while only two of them had a target uric acid level of less than 6.0 mg/dl; 13.7% of respondents took allopurinol at a different dosage (50 mg/day; 150–400 mg/day); 5.1% of patients took febuxostat; 13.8% of patients independently canceled the drug after a short course of administration, 8.0% received urate-lowering therapy sporadically, 2.9% do not tolerate urate-lowering drugs. The average uric acid level in the group receiving urate-lowering therapy was 7.5±0.2 mg/dl, and in the sample without therapy – 8.5±0.3 mg/dl (p<0.05); 70.3% of the surveyed patients reported that they did not follow a diet, only 13%, according to words, comply and 16.7% try to comply with the necessary restrictions in nutrition. 44.2% of patients from the group have never seen a rheumatologist, 33.3% have been treated once during the entire period of the disease, 19.6% are observed from time to time and only 2.9% of the entire group was regularly observed by a rheumatologist. When comparing groups of patients who have never seen a rheumatologist (group 1) and patients who have been examined at least once by a specialist (group 2), adherence to urate-lowering therapy and a low-purine diet is significantly higher in the second group.

Conclusion. The patients we examined showed low adherence to the treatment of gout: only 39.1% of them regularly took urate-lowering therapy, while 70.4% of those receiving therapy retained arthritis attacks and 75.9% of these patients did not reach the target uric acid level. Unsatisfactory control of gout is primarily associated with an insufficient dose of urate-lowering drugs taken, the lack of individual selection of therapy according to the level of uric acid. Ways to solve the problem, in our opinion, are to increase the level of knowledge of primary care physicians about the specifics of treatment and selection of anti-inflammatory drugs, increase awareness of people with gout about their disease, as well as more actively refer such patients to a rheumatologist.

Aim. To determine the frequency and factors contributing to the formation of c-ma "hyperechoic pyramids" in children born with very low and extremely low body weight, as well as to assess kidney function in this contingent of children in a three-year catamnesis.

Materials and methods. A comparative analysis of the ultrasound pattern of the urinary system was carried out in 756 premature babies, from birth to 3 years of age, two groups were identified: group I – 133 children who had hyperechoic pyramids in the neonatal period; group II – 643 children without hyperechoic pyramids in the neonatal period; group III – the comparison group – 3000 full-term neonates.

Results. The symptom of "hyperechoic pyramids" was detected in 15% of premature babies (group I) by the end of 1 month of life (25±6 days), in full-term babies (group III) – in 23 at the age of the first 3–10 days of life. In 2% of premature infants up to 2 months of age, hyperechoic inclusions were diagnosed, giving an acoustic shadow, which were interpreted as kidney concretions. It was revealed that the need (100% vs 71%) and duration (9.7 days vs 2.8 days) for mechanical ventilation, drug load and frequency of artificial feeding (92% vs 19%) in the I group were higher than in the II group. By 12 months of age, signs of nephrocalcinosis with hypercalciuria in group I were detected in 74% of patients and by 36 months were preserved in 23%. In 2% children with renal nodules detected in the first months of life, these changes up to 36 months of life and by 3 years of age, the frequency in group I was 6.6%.

Conclusion. In children born with very low and extremely low body weight, there is a high frequency of detection of "hyperechoic pyramids," which tends to decrease with the growth of the child. In some children, the changes are persistent with a risk of progression in the absence of proper observation and treatment. Among the aggravating external influences, a significant role belongs to long-term mechanical ventilation and oxygen dependence, high drug load by various groups of drugs, as well as artificial feeding in neonatal and infancy.