CARDIOVASCULAR THERAPY AND PREVENTION
ISSN / EISSN : 1728-8800 / 2619-0125
Current Publisher: Silicea - Poligraf, LLC (10.15829)
Total articles ≅ 742
Latest articles in this journal
CARDIOVASCULAR THERAPY AND PREVENTION, Volume 19; doi:10.15829/1728-8800-2020-2540
Reducing mortality due to cardiovascular complications (CVC) after non-cardiac surgery is one of the priority tasks of modern healthcare. According to the literature data, it is the CVC that are leading cause of perioperative mortality in non-cardiac surgery. Atrial fibrillation (AF) is a common complication after surgery. It is believed that in most cases the AF is potentiated by a combination of factors. It is intraoperative triggers, such as deliberate hypotension, anemia, injury, and pain, that can directly contribute to development of arrhythmia. However, heart rate monitoring after non-cardiac surgery is performed in only a small number of patients, so in most cases, arrhythmias remain unreported. The Revised Cardiac Risk Index (RCRI) and theAmericanCollegeof Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator are the current tools for assessing perioperative cardiovascular risk. Postoperative AF is not included in any CVC risk stratification system. The presented review systematizes the data that postoperative AF is closely associated with perioperative complications and in some cases it may be the only marker of these complications. It has been shown that AF detection is of great clinical importance in both high-risk patients and, especially, in patients with a low risk of potential complications in non-cardiac surgery.
CARDIOVASCULAR THERAPY AND PREVENTION, Volume 19; doi:10.15829/1728-8800-2020-2560
Aim. To study the prevalence of intermittent claudication (IC) and assess the risk of cardiovascular and all-cause death In Russian men with IC according to 30-year follow-up.Material and methods. The study used data obtained from representative samples of men examined inMoscow andSt. Petersburg (formerly known as Leningrad) from 1975 to 1986. Response rate was 75%. The examination of men (n=10953) aged 35-70 years (mean age 48,8±6,6 years) was carried out according to a single protocol, which included a standard survey, biochemical profile test, measurement of blood pressure (BP) and heart rate, anthropometry and 12-lead electrocardiography. To determine IC, the original Rose questionnaire was used, according to which four categories of pain were identified. The first is the absence of pain (P0); the second — mixed pain, including not associated with exercise (P1); the third — atypical pain in calf muscles lasting >10 minutes of rest (P2); the fourth — typical IC (P3). The median follow-up was 21,9 years. In total, 7,893 people died, including 4220 people due to cardiovascular diseases (CVD). The KaplanMeier curves was used to assess the associations between IC categories and survival. The risk of death, including due to CVD, was assessed using Cox proportional hazard models.Results. There were 38,8% of men with leg pain. The prevalence of IC in the studied sample was 1,0%, increasing with age from 0,4 to 2,3% in the older age group. As expected, individuals without leg pain live the longest. The years of life lost in persons with IC was 12. This parameter for cardiovascular deaths was 22,4 years. The contribution to survival not only of IC (P3), but also of atypical pain (P2) remains significant regardless of age. Moreover, the results of multivariate analysis showed that the contribution to mortality of P3 and P2 does not depend on increased blood pressure, smoking, ischemic and other electrocardiographic abnormalities, a history of myocardial infarction, which indicates the common etiology of lower limb and heart artery diseases. Similar data were obtained regarding cardiovascular mortality, however, the contribution of CI is more significant.Conclusion. IC In Russian men aged 35-70 years is an independent predictor of all-cause and cardiovascular death.
CARDIOVASCULAR THERAPY AND PREVENTION, Volume 19; doi:10.15829/1728-8800-2020-2561
Six-minute walk test (6MWT) is a simple and safe tool for assessing exercise tolerance in various categories of patients. Currently, 6MWT is used to assess the functional status of a patient and determine the strategy of increasing physical activity, primarily in patients with reduced exercise tolerance and contraindications for cardiopulmonary exercise test. The basic requirements for the 6MWT are presented, taking into account the factors affecting its informativeness and accuracy, as well as the interpretation of results. The diagnostic and prognostic value of 6MWT in different categories of patients are discussed. The prospects for 6MWT use in cardiac rehabilitation for planning rehabilitation program, prescribing exercises, determining the risk of complications, and evaluating the effectiveness are considered. The limitations of 6MWT and ways to overcome it, as well as directions for further research are presented.
Cardiovascular Therapy and Prevention, Volume 19; doi:10.15829/1728-8800-2020-2636
Aim. To study the features of biochemical and morphometric parameters in patients with type 2 diabetes (T2D) and cognitive impairment (CI).Material and methods. The experimental group included 72 patients with CI and T2D, the control group − 20 patients with T2D and without CI. We used the Montreal Cognitive Scale (MoCA) to assess the presence of CI. We also evaluated the levels of 1,5-anhydroglucitol (1,5-AG), continuous glucose monitoring (CGM), and data of brain magnetic resonance imaging (MRI).Results. We revealed that patients with T2D and CI have high HbA1c levels, but there was no significant difference of 1,5-AG levels between the groups. In patients with CI, we also established a decrease in gray and white matter surface area, as well as subcortical structures (the hippocampus, nucleus accumbens and putamen on both sides; the amygdala and globus pallidus on the right). The severity of CI correlated with polyneuropathy severity. In patients with proliferative retinopathy, there was a decrease in the volume of the caudate nucleus, globus pallidus, putamen and nucleus accumbens. Conclusion. The study revealed that patients with T2D with CI have worse levels of carbohydrate metabolism parameters, as well as a decrease in the cortical and subcortical brain structures.
Cardiovascular Therapy and Prevention, Volume 19; doi:10.15829/1728-8800-2020-2484
The article discusses a literature review reflecting the importance of identifying novel biomarkers in cardiology for improving conventional methods for diagnosing and stratifying risk in patients with acute coronary syndrome (ACS). Recently, more and more studies have published on such markers, in particular, on the proprotein convertase subtilisin/ kexin type 9 (PCSK9). The aim of this review was to analyze the associations of PCSK9 with clinical and laboratory parameters in patients with ACS. It has been demonstrated that the PCSK9 level in acute myocardial infarction is significantly increased. In patients with ACS, the level of PCSK9 is directly related to the duration of pain, the severity of coronary artery disease, familial hypercholesterolemia and lipid parameters, as well as the severity of coronary atherosclerosis according to the SYNTAX score. It was found that statin therapy before ACS significantly affects the association of PCSK9 with lipid profile. There are conflicting data on the associations of PCSK9 with the parameters of inflammatory response in ACS, as well as isolated evidence of the positive role of anti-IL-6 receptor monoclonal antibodies in ACS patients with dyslipidemia. The impact of PCSK9 on ACS prognosis is currently unstudied.
Cardiovascular Therapy and Prevention, Volume 19; doi:10.15829/1728-8800-2020-2630
The pandemic of the novel coronavirus infection (COVID-19), caused by SARS‑CoV‑2, has become a challenge to healthcare systems in all countries of the world. Patients with comorbidity are the most vulnerable group with the high risk of adverse outcomes. The problem of managing these patients in context of a pandemic requires a comprehensive approach aimed both at the optimal management in self-isolated patients not visiting medical facilities, and management of comorbidities in patients with COVID-19. The presented consensus covers these two aspects of managing patients with cardiovascular disease, diabetes, chronic obstructive pulmonary disease, gastrointestinal disease, and also pay attention to the multiple organ complications of COVID-19.
Cardiovascular Therapy and Prevention, Volume 19; doi:10.15829/1728-8800-2020-2612
Aim. To assess the effect of electrolyte changes on the prognosis of long-term cardiovascular events after acute coronary syndrome (ACS).Material and methods. The study included 105 patients with ACS who underwent coronary angiography (CA) with coronary stenting. At the study inclusion (before CA with coronary stenting), we collected data on traditional risk factors, analyzed levels of urinary sodium and potassium, kaliuresis and natriuresis. Free water clearance (FWC) and electrolyte free water clearance (EFWC), as well as fluid balance using bioelectrical impedance analysis were determined. Study endpoints (fatal and nonfatal cardiovascular events) were determined 6,2±0,2 months after CA with coronary stenting.Results. It was found that a decrease in urinary sodium (χ2=5,64, p=0,02, Constanta B0 =-0,62, Estimate =-16,5) and natriuresis (χ2=4,1, р=0,044, Constanta B0 =-1,38, Estimate =-5,2) increase the death risk. Urinary sodium of 0,2 mol/L and natriuresis of 0,5 mol are threshold levels of increased risk of death. Urinary potassium decrease was associated with an increase in death risk (threshold level — 0,5 mol/L, χ2=4,99, р=0,025, Constanta B0 =-0,63, Estimate =-70,4) and acute myocardial infarction (threshold level — 0,06 mol/L, χ2=3,93, р=0,04, Constanta B0 =-0,99, Estimate =-58,0) in the long-term period. Increase in EFWC increased the likelihood of long-term transient ischemic attack after ACS (χ2=4,61, р=0,03, Constanta B0 =-2,95, Estimate =-1,0). There were no significant relationships in the matter of FWC (p>0,05). However, with a decrease in intracellular fluid volume compared to normal values and a decrease in FWC or an increase in EFWC, the likelihood of longterm composite endpoints after ACS increases.Conclusion. As a result of the study, risk markers for long-term fatal and non-fatal cardiovascular events after ACS were established: decrease in urinary sodium
Cardiovascular Therapy and Prevention, Volume 19; doi:10.15829/1728-8800-2020-2587
Data on hepcidin levels in patients with heart failure (HF) are contradictory and do not make clear its contribution to the progression of multiple organ failure. There remain a number of issues about the prognostic significance of the N-terminal pro-brain natriuretic peptide (NT-proBNP) in HF with preserved ejection fraction (EF). The authors suggested the relationships between these markers in decompensated HF, as well as their associations with other clinical and laboratory parameters.Aim. To identify the association of NT-proBNP and hepcidin levels with clinical and laboratory parameters in patients with HF with various severity of left ventricular (LV) systolic dysfunction.Material and methods. The study included 68 patients (29 women, 39 men; mean age — 72,3±11,7 years) hospitalized due to decompensated HF. Patients were divided into three groups: reduced (HFrEF) (n=20), mid-range (HFmrEF) (n=23), and preserved EF (HFpEF) (n=24). Upon admission, along with standard diagnostic tests, all patients were examined for NT-proBNP and hepcidin levels by enzyme-linked immunosorbent assay. Statistical processing was carried out using the software package Statistica 8.0.Results. NT-proBNP levels in the entire sample was 315,9 [129,9; 576,1] pg/ml. Significantly higher concentrations of NT-proBNP were found in patients with lower EF: 433,05 (346,8-892,6) pg/ml for HFrEF, 289,97 (185,9-345,3) pg/ml for HFmrEF pg/ml and 214,98 (207,37-562,31) pg/ ml for HFpEF (pConclusion. Patients with lower EF showed higher NT-proBNP values and a trend towards higher hepcidin levels. Relationships of hepcidin and NT-proBNP levels with following clinical parameters were found: body mass index, presence of obstructive airway diseases, cardiac arrhythmias, as well as low cardiac output syndrome, cardiorenal syndrome and anemia.
Cardiovascular Therapy and Prevention, Volume 19; doi:10.15829/1728-8800-2020-2609
Aim. To analyze changes in the pattern of lipid-lowering therapy (LLT) in outpatients with stable coronary artery disease (SCAD) over the 7-year period.Material and methods. This pharmacoepidemiological, retrospective, cross-sectional, two-stage study was conducted on the basis of primary care facility of Moscow. We analyzed 1,834 and 805 medical records of patients with SCAD at the first (2011) and second (2018) stages, respectively. Data on demography, medical history, lipid profile, and administrated LLT were collected. Statistical analysis was performed using SPSS Statistics V16.0 and MS Excel. Differences were considered significant at pResults. Overall LLT prescription rate in outpatients with SCAD increased from 48,5 up to 86,4% (pConclusion. The results demonstrated significant improvements in the LLT pattern over the 7-year period in outpatients with SCAD. Number of patients receiving statins doubled, and the cases of prescribing lowintensity LLT have become very rare. However, control of blood lipids in the target group remained inadequate.
Cardiovascular Therapy and Prevention, Volume 19; doi:10.15829/1728-8800-2020-2592
The high prevalence of varicose veins has been established in numerous population studies. Currently, guidelines have been developed for the treatment of patients with varicose veins for various stages of chronic venous insufficiency. Nevertheless, despite the use of modern drugs, leg compression, surgical and other interventions, it is not possible to completely reverse the symptoms of venous insufficiency. The article is devoted to the analysis of micronized flavonoid purified fraction. The development of modern drugs for chronic venous diseases is an important direction in medicine. The creation of a drug pool manufactured InRussiais a priority in the development of the country’s pharmaceutical industry. The review presents data on the study of Detravenol (Russia), which is a combination of diosmin and hesperidin (micronized purified flavonoid fraction).