Vol 20, No 5 (2018)

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.

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

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

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

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