Vol 19, No 12 (2017)

Hypercholesterolemia is the most important risk factor for the development and progression of atherosclerosis in almost all populations, including the Russian Federation. Inhibitors of HMG-CoA reductase (statins) - the most well-known and well-studied class of lipid-lowering drugs with a convincing evidence base for reducing the risk of cardiovascular and total mortality. Rosuvastatin (Crestor®) - statin of the 4th generation, used in daily doses of 5-40 mg, has maximal activity in inhibiting HMG-CoA reductase and, accordingly, lowering the level of low-density lipoprotein cholesterol, has been well studied in the clinical studies program GALAXY in the period 2004-2011 In 2016, the European Society for the Study of Atherosclerosis and the European Society of Cardiology (EAS/ESC) on the diagnosis and treatment of dyslipidemias published a regular recommendation, in which statin therapy in patients with high cardiovascular risk is a priority (evidence of IA). This article discusses the role of classical studies of rosuvastatin from the GALAXY project in the light of the recommendations on dyslipidemia in 2016, as well as the current strategy of treatment with HMG-CoA reductase inhibitors in primary prevention patients with type 2 diabetes mellitus, patients with carotid arteriosclerosis, and platelet stabilization issues are discussed on the background of intensive therapy with statins.

Conception of major principles in diagnostics and differential diagnostics of angina was proposed according to the authors` clinical practice and modern notions. The structure, sequence and mechanism of medical diagnostic search are observed in the study. Principles and approaches to solving differential diagnostics problems are performed from up-to-date attitude.

This study demonstrates the effectiveness of procainamide, propafenone and amiodarone for pharmacological cardioversion in patients with paroxysmal atrial fibrillation. The restoration of the sinus rhythm within 60 minutes was observed for propafenone 73.2%, for procainamide 55.00% and for amiodarone 16.13%. of cases.

The article presents an algorithm for choosing the optimal drug for the treatment of arterial hypertension. The main groups of antihypertensive drugs with the characteristic of the mechanism of their action and possible side effects are described. The authors described in detail the combined antihypertensive drug Triplixam® (Servier Laboratory). The results of multicenter randomized trials of patients with arterial hypertension are presented. On the basis of clinical studies, the high efficacy of Triplixam® in the treatment of arterial hypertension has been proven.

The review presents data on the efficacy, pleiotropic effects and safety of a new lercanidipine calcium channel blocker in the treatment of hypertension. This medicine is the high-selective lipophilic blocker of L-channels, duration of action is provided by its slow accumulation in the bilipid cell membranes, that does not cause activating of the sympathoadrenal system. Lercanidipine possesses an organoprotective effect, diminishes the hypertrophy of the left ventricle, improves the kidney function, has anantiproteinuric effect, has a good profile of safety, rarely causes peripheral edema as compared to other dihydropyridines, and is well combined with the intake of other medicines.

Based on the analysis of the sample of patients (n=400), a scoring scale was obtained and verified for self-assessment by patients with potassium availability. The total score estimates the potassium levels in the erythrocytes: a larger score on the scale corresponds to a better availability of the patient with potassium. Verification of the scale in the control sample of patients (n=200) showed a reliable correlation between scores and experimentally determined potassium levels in red blood cells, so that each scale score corresponds to +1 mmol/L potassium in erythrocytes. The scale allows for rapid assessment of the supply of potassium to the body.

The side effects of drugs, including renal and cardiovascular complications, are a topical medical problem throughout the world. The leading place in their development is occupied by non-steroidal anti-inflammatory drugs (NSAIDs), which are the most frequently prescribed classes of drugs. The mechanism of action of NSAIDs is associated with the block of synthesis of vasodilator renal prostaglandins due to inactivation of the cyclooxygenase enzyme. This can lead to the development of vasomotor nephropathy, acute tubulointerstitial nephritis, chronic kidney disease and other renal side effects. In patients with hypertension, NSAIDs can lead to both a significant increase in blood pressure and a change in the pharmacokinetics of the antihypertensive drugs. Therefore, the appointment of NSAIDs should be strictly regulated, health workers should use minimally effective doses and duration of use; need competencies in cardiovascular and renal risk factors assessment.

Due to growth of prevalence of diabetes mellitus type 1 (DM 1) among young children new ISPAD (International Society for Pediatric and Adolescent Diabetes) Consensus on Managing diabetes in preschool children was developed. Glycosylated hemoglobin A1c level for preschool children is recommended to keep below 7.5%. Basic causes of non-reaching of glycemic goals are considered unpredictability of meals and physical activity in young children, fear of parents in front of hypoglycemia, glycemic variability. Reaching the goals is supported by positive attitude to self-control procedures, education of patients’ relatives taking into account the age of a child, precise glycemic control from the first months of disease. For satisfactory glycemic control it is recommended to measure glycaemia 7-10 times per day; to use only the most precise glucometers; to teach patient family members correct exploitation of glucometer. Grownups should encourage self-dependence of a child, but all of such manipulations should be controlled by grownups. In the article own data are given - results of 30 patients questionnaire on glycosylated hemoglobin level, age when they stated to use glucometer themselves, frequency of glycaemia measurements.