Pub Date : 2023-07-27DOI: 10.20996/1819-6446-2023-2922
S. Gilyarevsky, N. Vereina, M. Golshmid
The article is devoted to the discussion of modern approaches to the use of laboratory methods to improve the tactics of using direct oral anticoagulants (DOACs) therapy. Clinical situations in which it may be reasonable to use data on the blood concentration of DOACs are given, including very old age, a marked deviation from the norm of body weight or impaired renal function. Data on the role of measuring the blood level of DOACs are considered in cases of the development of diseases or complications in which information is required on the preservation of the anticoagulant effect of DOACs, for example, in the development of severe bleeding or the need for urgent surgical intervention. The advantages and limitations of modern laboratory methods for assessing the blood concentration of DOACs are discussed. It is emphasized that one of the main advantages of using DOACs is the absence of the need to monitor laboratory parameters in most patients. Data from pharmacological studies are presented that may be useful in explaining the mechanisms that determine the higher safety of some DOACs compared to others. Promising methods for assessing the blood level of DOACs, as well as the possibility of using less specific reagents for assessing the concentration of DOACs, are considered. The possibility of using less specific, but more accessible methods for assessing the blood concentration of factor Xa inhibitors, in particular, a reagent for assessing the level of the antifactor, which is used to determine the blood level of heparin, is being considered. The opinions of experts on the role of assessing the blood level of DOACs and the possibility of tactics for selecting doses of DOACs based on laboratory analysis data are given.
{"title":"Current insights into the possible role of laboratory monitoring of effectiveness and safety of direct oral anticoagulants","authors":"S. Gilyarevsky, N. Vereina, M. Golshmid","doi":"10.20996/1819-6446-2023-2922","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-2922","url":null,"abstract":"The article is devoted to the discussion of modern approaches to the use of laboratory methods to improve the tactics of using direct oral anticoagulants (DOACs) therapy. Clinical situations in which it may be reasonable to use data on the blood concentration of DOACs are given, including very old age, a marked deviation from the norm of body weight or impaired renal function. Data on the role of measuring the blood level of DOACs are considered in cases of the development of diseases or complications in which information is required on the preservation of the anticoagulant effect of DOACs, for example, in the development of severe bleeding or the need for urgent surgical intervention. The advantages and limitations of modern laboratory methods for assessing the blood concentration of DOACs are discussed. It is emphasized that one of the main advantages of using DOACs is the absence of the need to monitor laboratory parameters in most patients. Data from pharmacological studies are presented that may be useful in explaining the mechanisms that determine the higher safety of some DOACs compared to others. Promising methods for assessing the blood level of DOACs, as well as the possibility of using less specific reagents for assessing the concentration of DOACs, are considered. The possibility of using less specific, but more accessible methods for assessing the blood concentration of factor Xa inhibitors, in particular, a reagent for assessing the level of the antifactor, which is used to determine the blood level of heparin, is being considered. The opinions of experts on the role of assessing the blood level of DOACs and the possibility of tactics for selecting doses of DOACs based on laboratory analysis data are given.","PeriodicalId":20812,"journal":{"name":"Rational Pharmacotherapy in Cardiology","volume":"141 2 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91111228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-27DOI: 10.20996/1819-6446-2023-2878
A. Kovalskaya, D. Duplyakov
Aim. To study the role of biomarkers in assessing the vulnerability of atherosclerotic plaques.Material and methods. A review of literature sources investigating the biomarker assessment of the vulnerability of atherosclerotic plaques published for the period 01.01.2016 to 31.12.2022 was carried out. Literature search was carried out in English and Russian in PubMed databases, in Google Academy, Elibrary.ru according to the following keywords: “biomarkers of plaque vulnerability”, “NLR and vulnerable plaque”, “CRP and vulnerable plaque”, ”MMP-9 and vulnerable plaque”, “TIMP-1 and vulnerable plaque”, ”galectin-3 and vulnerable plaque”, “NGAL and vulnerable plaque”. A total of 183 articles were found, of which 42 articles in full-text format containing original clinical studies were selected for the preparation of this review.Results. Numerous studies have shown that the vulnerability and rupture of the plaque, rather than its size and severity of stenosis, are the main cause of cardiovascular events in patients with coronary heart disease. Small plaques rich in lipids often become unstable due to an inflammatory reaction supported by the interaction between lipoproteins, monocytes, macrophages, T-lymphocytes and vascular wall cells. NLR, CRP, NGAL, Galectin-3, as well as markers of extracellular matrix degradation (MMP-9, TIMP-1) can play a special role in assessing the vulnerability of plaques.Conclusion. The development of acute coronary syndrome is based on the destabilization of the atherosclerotic plaque, which occurs not only due to changes in its lipid composition, but also infiltration by immuno-inflammatory cells, degradation of the extracellular matrix, as well as an active inflammatory reaction and neovascularization of the plaque. Therefore, traditional imaging methods that characterize the plaque by its appearance and size are not enough to predict the risk of rupture and the development of an acute thrombotic event. Thus, there is a need to identify new biomarkers that would correlate with the instability of plaque atheroma.
{"title":"Biomarkers in assessing the vulnerability of atherosclerotic plaques: a narrative review","authors":"A. Kovalskaya, D. Duplyakov","doi":"10.20996/1819-6446-2023-2878","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-2878","url":null,"abstract":"Aim. To study the role of biomarkers in assessing the vulnerability of atherosclerotic plaques.Material and methods. A review of literature sources investigating the biomarker assessment of the vulnerability of atherosclerotic plaques published for the period 01.01.2016 to 31.12.2022 was carried out. Literature search was carried out in English and Russian in PubMed databases, in Google Academy, Elibrary.ru according to the following keywords: “biomarkers of plaque vulnerability”, “NLR and vulnerable plaque”, “CRP and vulnerable plaque”, ”MMP-9 and vulnerable plaque”, “TIMP-1 and vulnerable plaque”, ”galectin-3 and vulnerable plaque”, “NGAL and vulnerable plaque”. A total of 183 articles were found, of which 42 articles in full-text format containing original clinical studies were selected for the preparation of this review.Results. Numerous studies have shown that the vulnerability and rupture of the plaque, rather than its size and severity of stenosis, are the main cause of cardiovascular events in patients with coronary heart disease. Small plaques rich in lipids often become unstable due to an inflammatory reaction supported by the interaction between lipoproteins, monocytes, macrophages, T-lymphocytes and vascular wall cells. NLR, CRP, NGAL, Galectin-3, as well as markers of extracellular matrix degradation (MMP-9, TIMP-1) can play a special role in assessing the vulnerability of plaques.Conclusion. The development of acute coronary syndrome is based on the destabilization of the atherosclerotic plaque, which occurs not only due to changes in its lipid composition, but also infiltration by immuno-inflammatory cells, degradation of the extracellular matrix, as well as an active inflammatory reaction and neovascularization of the plaque. Therefore, traditional imaging methods that characterize the plaque by its appearance and size are not enough to predict the risk of rupture and the development of an acute thrombotic event. Thus, there is a need to identify new biomarkers that would correlate with the instability of plaque atheroma.","PeriodicalId":20812,"journal":{"name":"Rational Pharmacotherapy in Cardiology","volume":"os8 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88404313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-27DOI: 10.20996/1819-6446-2023-2924
S. Martsevich, N. Kutishenko, Y. Lukina, O. Drapkina
The review is devoted to a modern problem of polypharmacy. A universal definition and clear criteria for this concept have not yet been formed, but it is believed that this is the prescribing of at least 5 medications (M). The article discusses the frequency and main causes of polypharmacy, demonstrates its clear relationship with the age. The presence of overweight and obesity, multimorbidity, low physical activity, fragility are clearly associated with polypharmacy. Cognitive impairment, disability, long-term pain syndrome and malignant diseases also predispose to polypharmacy. The absence of a permanent attending physician, living in a nursing home, consulting with several specialists, poor management of medical records are associated with polypharmacy. It is believed that polypharmacy leads to a following number of adverse consequences: it increases the risk of falls, side effects of M, hospitalizations and even death. The main reason for this is the occurrence of various adverse interactions between M, including unpredictable ones, but the causal relationship of these phenomena with polypharmacy is not always proven. To study of adherence to prescribed therapy with polypharmacy is not an easy task, to date, there is no clear answer to the question whether polypharmacy affects adherence to drug therapy. The article presents in detail the problems of potentially irrational prescriptions, discusses the main methods of preventing and combating polypharmacy. Obviously, the most acceptable methods are the cancellation of drugs that are not indicated or contraindicated to the patient, and the prescribing of those drugs for which there are direct indications, but which the patient does not receive. The patient’s therapy should be individualized as much as possible, taking into account numerous factors related to the peculiarities of the disease course, the prognosis, the patient’s lifestyle, his physical and mental status.
{"title":"Polypharmacy: definition, impact on outcomes, need for correction","authors":"S. Martsevich, N. Kutishenko, Y. Lukina, O. Drapkina","doi":"10.20996/1819-6446-2023-2924","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-2924","url":null,"abstract":"The review is devoted to a modern problem of polypharmacy. A universal definition and clear criteria for this concept have not yet been formed, but it is believed that this is the prescribing of at least 5 medications (M). The article discusses the frequency and main causes of polypharmacy, demonstrates its clear relationship with the age. The presence of overweight and obesity, multimorbidity, low physical activity, fragility are clearly associated with polypharmacy. Cognitive impairment, disability, long-term pain syndrome and malignant diseases also predispose to polypharmacy. The absence of a permanent attending physician, living in a nursing home, consulting with several specialists, poor management of medical records are associated with polypharmacy. It is believed that polypharmacy leads to a following number of adverse consequences: it increases the risk of falls, side effects of M, hospitalizations and even death. The main reason for this is the occurrence of various adverse interactions between M, including unpredictable ones, but the causal relationship of these phenomena with polypharmacy is not always proven. To study of adherence to prescribed therapy with polypharmacy is not an easy task, to date, there is no clear answer to the question whether polypharmacy affects adherence to drug therapy. The article presents in detail the problems of potentially irrational prescriptions, discusses the main methods of preventing and combating polypharmacy. Obviously, the most acceptable methods are the cancellation of drugs that are not indicated or contraindicated to the patient, and the prescribing of those drugs for which there are direct indications, but which the patient does not receive. The patient’s therapy should be individualized as much as possible, taking into account numerous factors related to the peculiarities of the disease course, the prognosis, the patient’s lifestyle, his physical and mental status.","PeriodicalId":20812,"journal":{"name":"Rational Pharmacotherapy in Cardiology","volume":"11 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83982466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-27DOI: 10.20996/1819-6446-2023-2914
A. Gurbanova, K. Pereverzeva, S. Yakushin, I. V. Budanova
The article analyzes the case of the development of ventricular tachycardia and type 2 myocardial infarction (MI) in an 80-year-old patient with a history of coronary artery disease, MI and chronic heart failure. In 2020, the patient was diagnosed with ventricular extrasystole and started antiarrhythmic therapy with diethylamino propionylethoxycarbonylaminophenothiazine 150 mg per day and sotalol 160 mg per day. In 2022, the patient had an episode of clinical death due to ventricular tachycardia with successful resuscitation. A diagnosis of non-ST-elevation acute coronary syndrome was made, coronary angiography was performed, which did not reveal significant coronary stenosis. Upon further examination, the dynamics of biomarkers of myocardial necrosis confirmed the diagnosis of acute MI. In the analyzed case, the development of ventricular tachycardia and MI is most likely associated with the intake of diethylaminopropionylethoxycarbonylaminophenothiazine in combination with sotalol, prescribed in the presence of contraindications to their use.
{"title":"Ventricular tachycardia and myocardial infarction during antiarrhythmic therapy: a case report","authors":"A. Gurbanova, K. Pereverzeva, S. Yakushin, I. V. Budanova","doi":"10.20996/1819-6446-2023-2914","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-2914","url":null,"abstract":"The article analyzes the case of the development of ventricular tachycardia and type 2 myocardial infarction (MI) in an 80-year-old patient with a history of coronary artery disease, MI and chronic heart failure. In 2020, the patient was diagnosed with ventricular extrasystole and started antiarrhythmic therapy with diethylamino propionylethoxycarbonylaminophenothiazine 150 mg per day and sotalol 160 mg per day. In 2022, the patient had an episode of clinical death due to ventricular tachycardia with successful resuscitation. A diagnosis of non-ST-elevation acute coronary syndrome was made, coronary angiography was performed, which did not reveal significant coronary stenosis. Upon further examination, the dynamics of biomarkers of myocardial necrosis confirmed the diagnosis of acute MI. In the analyzed case, the development of ventricular tachycardia and MI is most likely associated with the intake of diethylaminopropionylethoxycarbonylaminophenothiazine in combination with sotalol, prescribed in the presence of contraindications to their use.","PeriodicalId":20812,"journal":{"name":"Rational Pharmacotherapy in Cardiology","volume":"8 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85545049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-27DOI: 10.20996/1819-6446-2023-2894
M. Kozhevnikova, E. O. Korobkova, A. V. Krivova, A. Kukharenko, N. Moskaleva, K. Shestakova, N. Mesonzhnik, A. Ageev, A. A. Boldin, A. Brito, S. Appolonova, E. Privalova, Y. Belenkov
Aim. Branched-chain amino acids (BCAAs) have been postulated as potential indicators of cardiovascular risk. The objective of this study was to explore the relationship between plasma BCAAs and different stages of cardiovascular disorders.Material and methods. In our cross-sectional study, plasma BCAAs (valine, leucine and isoleucine) in individuals without cardiovascular diseases (CVDs) (nonCVD group, total n=27, with n=16 healthy, but with metabolic disorders) were compared to patients diagnosed with CVDs [CVD group, total n=109, being n=61 hypertension (n=31 with signs of beginning of myocardial remodeling) and n=48 patients with coronary artery disease (CAD)].Results. The plasma concentration of BCAAs was significantly higher in the group of patients with cardiovascular disease compared with the healthy group (p<0.05 for all amino acids tested): valine concentration was 238.7 [219.6; 267.0] μM in the non-CVD group and 261.2 [233.8; 298.7] μM in the CVD group; leucine concentration was 134.8 [122.4; 153.2] μM and 146.8 [129.0; 166.6] μM, respectively; and isoleucine 72.7 [65.3; 84.4] μM and 81.7 [68.0; 96.2] μM, respectively. Leucine and isoleucine concentration levels were minimal in the healthy participant subgroup and maximal in the IBS patient subgroup. No statistically significant differences in BCAAs concentrations were found in the subgroups without CAD. Significant increases in concentrations were observed in the subgroups of patients with CAD as follows: valine concentration was 256.3 [219.0; 297.9] μM in hypertension group and 261.7 [236.5; 307.5] μM in CAD group; leucine concentration was 141.8 [123.5; 166.6] μM and 154.1 [134.7; 172.7] μM, respectively, and isoleucine 72.8 [65.7; 94.0] μM and 85.7 [74.9; 101.7] μM, respectively. BCAAs profiles in all participants with metabolic disorders had “good” diagnostic accuracy with area under the receiver operating characteristics curve being 0.72, 0.70 and 0.70 for valine, leucine and isoleucine, respectively.Conclusion. BCAAs concentrations are elevated with higher severity of the cardiovascular disorder and exhibit potential as early independent indicators of coronary artery disease.
{"title":"Plasma branched-chain amino acid concentrations in individuals without cardiovascular diseases versus patients diagnosed with hypertension and coronary artery disease","authors":"M. Kozhevnikova, E. O. Korobkova, A. V. Krivova, A. Kukharenko, N. Moskaleva, K. Shestakova, N. Mesonzhnik, A. Ageev, A. A. Boldin, A. Brito, S. Appolonova, E. Privalova, Y. Belenkov","doi":"10.20996/1819-6446-2023-2894","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-2894","url":null,"abstract":"Aim. Branched-chain amino acids (BCAAs) have been postulated as potential indicators of cardiovascular risk. The objective of this study was to explore the relationship between plasma BCAAs and different stages of cardiovascular disorders.Material and methods. In our cross-sectional study, plasma BCAAs (valine, leucine and isoleucine) in individuals without cardiovascular diseases (CVDs) (nonCVD group, total n=27, with n=16 healthy, but with metabolic disorders) were compared to patients diagnosed with CVDs [CVD group, total n=109, being n=61 hypertension (n=31 with signs of beginning of myocardial remodeling) and n=48 patients with coronary artery disease (CAD)].Results. The plasma concentration of BCAAs was significantly higher in the group of patients with cardiovascular disease compared with the healthy group (p<0.05 for all amino acids tested): valine concentration was 238.7 [219.6; 267.0] μM in the non-CVD group and 261.2 [233.8; 298.7] μM in the CVD group; leucine concentration was 134.8 [122.4; 153.2] μM and 146.8 [129.0; 166.6] μM, respectively; and isoleucine 72.7 [65.3; 84.4] μM and 81.7 [68.0; 96.2] μM, respectively. Leucine and isoleucine concentration levels were minimal in the healthy participant subgroup and maximal in the IBS patient subgroup. No statistically significant differences in BCAAs concentrations were found in the subgroups without CAD. Significant increases in concentrations were observed in the subgroups of patients with CAD as follows: valine concentration was 256.3 [219.0; 297.9] μM in hypertension group and 261.7 [236.5; 307.5] μM in CAD group; leucine concentration was 141.8 [123.5; 166.6] μM and 154.1 [134.7; 172.7] μM, respectively, and isoleucine 72.8 [65.7; 94.0] μM and 85.7 [74.9; 101.7] μM, respectively. BCAAs profiles in all participants with metabolic disorders had “good” diagnostic accuracy with area under the receiver operating characteristics curve being 0.72, 0.70 and 0.70 for valine, leucine and isoleucine, respectively.Conclusion. BCAAs concentrations are elevated with higher severity of the cardiovascular disorder and exhibit potential as early independent indicators of coronary artery disease.","PeriodicalId":20812,"journal":{"name":"Rational Pharmacotherapy in Cardiology","volume":"12 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84950715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-27DOI: 10.20996/1819-6446-2023-2689
E. Kotova, A. Moiseeva, E. Domonova, O. Y. Silveytrova, A. Pisaryuk, P. V. Kakhktsyan, J. I. Babukhina, Z. Kobalava
A clinical observation of the treatment non-compliance consequences with clinical guidelines and principles of empirical therapy selection in a female patient with intravenous drug abuse, viral hepatitis C and HIV infection, with a history of a COVID-19 and the development of uncontrolled staphylococcal infective endocarditis (IE) of the tricuspid valve, complicated recurrence of early prosthetic IE is presented. Successful treatment was achieved only by a combination of tricuspid valve replacement and the appointment of etiotropic therapy for S. aureus (MSSA). The typical clinical scenario was not accompanied by the choice of adequate empirical antibiotic therapy, despite the high suspicion of association with MSSA, which determined the complicated course of IE. Only the polymerase chain reaction of the heart valve tissue played a key role in the etiological diagnosis. The use of valve tissue polymerase chain reaction in addition to traditional microbiological methods is a valuable diagnostic study.
{"title":"Intractable complicated course of tricuspid valve infective endocarditis due to non-compliance of treatment with clinical guidelines with a decisive role of molecular biological study in etiological diagnosis: a case report","authors":"E. Kotova, A. Moiseeva, E. Domonova, O. Y. Silveytrova, A. Pisaryuk, P. V. Kakhktsyan, J. I. Babukhina, Z. Kobalava","doi":"10.20996/1819-6446-2023-2689","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-2689","url":null,"abstract":"A clinical observation of the treatment non-compliance consequences with clinical guidelines and principles of empirical therapy selection in a female patient with intravenous drug abuse, viral hepatitis C and HIV infection, with a history of a COVID-19 and the development of uncontrolled staphylococcal infective endocarditis (IE) of the tricuspid valve, complicated recurrence of early prosthetic IE is presented. Successful treatment was achieved only by a combination of tricuspid valve replacement and the appointment of etiotropic therapy for S. aureus (MSSA). The typical clinical scenario was not accompanied by the choice of adequate empirical antibiotic therapy, despite the high suspicion of association with MSSA, which determined the complicated course of IE. Only the polymerase chain reaction of the heart valve tissue played a key role in the etiological diagnosis. The use of valve tissue polymerase chain reaction in addition to traditional microbiological methods is a valuable diagnostic study.","PeriodicalId":20812,"journal":{"name":"Rational Pharmacotherapy in Cardiology","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91385968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-11DOI: 10.20996/1819-6446-2023-2913
O. F. Egorkina, G. N. Soboleva, S. Gaman, Y. A. Karpov, S. Ternovoy
A case of a patient with myocardial perfusion improvement according to volume computed tomography (VCT) of the heart with triphosadenine infusion against the background of optimal therapy, including nicorandil for 3,5 years, is presented. In a patient with an established diagnosis of non-obstructive coronary artery disease (CAD) in 2019, stress-induced myocardial ischemia of left ventricular (LV) septal and lateral area was detected. Repeated investigation 3,5 years later against the background of optimal therapy showed an ischemia decrease in the form of the disappearance of previously detected defects in the basal segments of the anteriorlateral and inferior-lateral walls and the middle segments of the anterior-septal and inferior-lateral walls of the LV.
{"title":"Effect of long-term nicorandil therapy on myocardial perfusion parameters according to triphosadenine stress-volume computed tomography in a patient with non-obstructive coronary artery disease: a care report","authors":"O. F. Egorkina, G. N. Soboleva, S. Gaman, Y. A. Karpov, S. Ternovoy","doi":"10.20996/1819-6446-2023-2913","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-2913","url":null,"abstract":"A case of a patient with myocardial perfusion improvement according to volume computed tomography (VCT) of the heart with triphosadenine infusion against the background of optimal therapy, including nicorandil for 3,5 years, is presented. In a patient with an established diagnosis of non-obstructive coronary artery disease (CAD) in 2019, stress-induced myocardial ischemia of left ventricular (LV) septal and lateral area was detected. Repeated investigation 3,5 years later against the background of optimal therapy showed an ischemia decrease in the form of the disappearance of previously detected defects in the basal segments of the anteriorlateral and inferior-lateral walls and the middle segments of the anterior-septal and inferior-lateral walls of the LV.","PeriodicalId":20812,"journal":{"name":"Rational Pharmacotherapy in Cardiology","volume":"15 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139360510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-11DOI: 10.20996/10.20996/1819-6446-2023-2918
S. Gilyarevsky, D. O. Ladygina
The literature review is devoted to modern ideas about the role of hyperaldosteronism as one of the important pathophysiological links in hypertension (HTN) development. Data are presented on aldosterone synthesis mechanisms both in healthy and sick people, in particular in primary aldosteronism (PA), as well as in some cases of secondary aldosteronism. The results of modern studies are discussed, which established autonomous formation of aldosterone in elderly and senile people even without formal criteria for PA. The most important stages of studying and solving the hyperaldosteronism problem using surgical or conservative methods areconsidered. Data are presented on target organ damage caused by an increased blood concentration of aldosterone. The influence of the interaction between increased dietary sodium intake and the severity of cardiovascular damage is discussed. Separately, the role of subclinical hyperaldosteronism in the development of hypertension is considered, as well as the possibility of target organ damage in such cases, despite the normal blood pressure level. Modern data on the role of mineralocorticoid receptor antagonists (MRAs), in particular spironolactone, in the treatment of hyperaldosteronism and resistant hypertension are presented. The limitations of MRA use, which are mainly due to reduced kidney function, are considered. In particular, the results of the most important clinical studies are discussed, which became the basis for higher prescription rate of MRAs in the treatment of hypertensive patients.
这篇文献综述探讨了高醛固酮增多症作为高血压（HTN）发病的重要病理生理环节之一的现代观点。文章介绍了健康人和病人的醛固酮合成机制，特别是原发性醛固酮增多症（PA）和一些继发性醛固酮增多症病例的醛固酮合成机制。讨论了现代研究的结果，这些结果确定了老年人和老龄人体内醛固酮的自主形成，即使没有 PA 的正式标准。考虑了使用手术或保守方法研究和解决高醛固酮症问题的最重要阶段。介绍了血液中醛固酮浓度升高对靶器官造成损害的数据。讨论了膳食钠摄入量增加与心血管损害严重程度之间相互作用的影响。另外，还考虑了亚临床高醛固酮血症在高血压发病中的作用，以及在这种情况下，尽管血压水平正常，但仍有可能造成靶器官损害。介绍了有关矿质皮质激素受体拮抗剂（MRA），特别是螺内酯在治疗高醛固酮症和抵抗性高血压中的作用的现代数据。还考虑了使用 MRA 的局限性，这主要是由于肾功能减退造成的。特别讨论了最重要的临床研究结果，这些研究结果是提高 MRAs 治疗高血压患者处方率的基础。
{"title":"Paradigm shift on the role of mineralocorticoid receptor antagonists in hypertension therapy","authors":"S. Gilyarevsky, D. O. Ladygina","doi":"10.20996/10.20996/1819-6446-2023-2918","DOIUrl":"https://doi.org/10.20996/10.20996/1819-6446-2023-2918","url":null,"abstract":"The literature review is devoted to modern ideas about the role of hyperaldosteronism as one of the important pathophysiological links in hypertension (HTN) development. Data are presented on aldosterone synthesis mechanisms both in healthy and sick people, in particular in primary aldosteronism (PA), as well as in some cases of secondary aldosteronism. The results of modern studies are discussed, which established autonomous formation of aldosterone in elderly and senile people even without formal criteria for PA. The most important stages of studying and solving the hyperaldosteronism problem using surgical or conservative methods areconsidered. Data are presented on target organ damage caused by an increased blood concentration of aldosterone. The influence of the interaction between increased dietary sodium intake and the severity of cardiovascular damage is discussed. Separately, the role of subclinical hyperaldosteronism in the development of hypertension is considered, as well as the possibility of target organ damage in such cases, despite the normal blood pressure level. Modern data on the role of mineralocorticoid receptor antagonists (MRAs), in particular spironolactone, in the treatment of hyperaldosteronism and resistant hypertension are presented. The limitations of MRA use, which are mainly due to reduced kidney function, are considered. In particular, the results of the most important clinical studies are discussed, which became the basis for higher prescription rate of MRAs in the treatment of hypertensive patients.","PeriodicalId":20812,"journal":{"name":"Rational Pharmacotherapy in Cardiology","volume":"75 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139360398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-17DOI: 10.20996/1819-6446-2023-04-04
M. Ezhov, N. Akhmedzhanov, T. E. Kolmakova, A. Tyurina, A. Martynov
Aim. To study the frequency of prescriptions of various types of lipid-lowering therapy and their effectiveness in outpatient clinical practice based on the results of a questionnaire of primary care physicians.Material and methods. The study was performed in 2022 in 75 constituent entities of the Russian Federation with the participation of 1117 doctors working in outpatient clinics. Most of the doctors had work experience of 10-20 years or more. Doctors of polyclinics (therapists and cardiologists, etc.) before the start of the study received instructions, questionnaires for filling out, developed by the National Atherosclerosis Society. The frequency of prescriptions by primary care physicians of various types of lipid-lowering therapy and their effectiveness in terms of the frequency of achieving target levels of low-density lipoprotein cholesterol (LDL-C) was studied based on the results of a questionnaire.Results. Monotherapy with statins was prescribed in 55.2% of cases, free combination of rosuvastatin with ezetimibe – in 17.2%, single pill combination of rosuvastatin with ezetimibe – in 23.2%, combination therapy with PCSK9 inhibitors – in 4.1% of cases. Target levels of LDL-C ˂ 1.8 mmol/l and ˂ 1.4 mmol/l were achieved with statin monotherapy in 42.6% and 28.2% of cases, respectively, free combination of rosuvastatin with ezetimibe – in 61.7% and 39 .5%, a fixed combination of rosuvastatin with ezetimibe – in 67.8% and 48.5%, combination therapy with PCSK9 inhibitors – in 96.8% and 92.8% of cases.Conclusion. The single pill combination of rosuvastatin with ezetimibe is more effective in achieving target levels of LDL-C compared with statin monotherapy and therapy with free combination of statin with ezetimibe. Despite the fact that the target values of LDL-C when prescribing a combination with PCSK9 inhibitors were achieved in 96.8% and 92.8% of cases, they were used quite rarely at the outpatient stage of treatment in the Russian Federation.
{"title":"Outpatient Practice of Lipid-Lowering Therapy Prescription (According to the ARGO-3 Study)","authors":"M. Ezhov, N. Akhmedzhanov, T. E. Kolmakova, A. Tyurina, A. Martynov","doi":"10.20996/1819-6446-2023-04-04","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-04-04","url":null,"abstract":"Aim. To study the frequency of prescriptions of various types of lipid-lowering therapy and their effectiveness in outpatient clinical practice based on the results of a questionnaire of primary care physicians.Material and methods. The study was performed in 2022 in 75 constituent entities of the Russian Federation with the participation of 1117 doctors working in outpatient clinics. Most of the doctors had work experience of 10-20 years or more. Doctors of polyclinics (therapists and cardiologists, etc.) before the start of the study received instructions, questionnaires for filling out, developed by the National Atherosclerosis Society. The frequency of prescriptions by primary care physicians of various types of lipid-lowering therapy and their effectiveness in terms of the frequency of achieving target levels of low-density lipoprotein cholesterol (LDL-C) was studied based on the results of a questionnaire.Results. Monotherapy with statins was prescribed in 55.2% of cases, free combination of rosuvastatin with ezetimibe – in 17.2%, single pill combination of rosuvastatin with ezetimibe – in 23.2%, combination therapy with PCSK9 inhibitors – in 4.1% of cases. Target levels of LDL-C ˂ 1.8 mmol/l and ˂ 1.4 mmol/l were achieved with statin monotherapy in 42.6% and 28.2% of cases, respectively, free combination of rosuvastatin with ezetimibe – in 61.7% and 39 .5%, a fixed combination of rosuvastatin with ezetimibe – in 67.8% and 48.5%, combination therapy with PCSK9 inhibitors – in 96.8% and 92.8% of cases.Conclusion. The single pill combination of rosuvastatin with ezetimibe is more effective in achieving target levels of LDL-C compared with statin monotherapy and therapy with free combination of statin with ezetimibe. Despite the fact that the target values of LDL-C when prescribing a combination with PCSK9 inhibitors were achieved in 96.8% and 92.8% of cases, they were used quite rarely at the outpatient stage of treatment in the Russian Federation.","PeriodicalId":20812,"journal":{"name":"Rational Pharmacotherapy in Cardiology","volume":"44 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91332688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-12DOI: 10.20996/1819-6446-2023-03-03
Y. Vasyuk, E. Shupenina, A. G. Nosova, E. Novosel, D. Vyzhigin
Cardiovascular and oncological diseases are the leading causes of adult death in the world. Despite proven efficacy, anticancer drugs can cause severe cardiovascular complications. Recently, data have appeared on the possible vasotoxic effects of chemotherapy drugs, which can manifest themselves as the progression of arterial hypertension and atherosclerosis, the development of myocardial ischemia and acute coronary syndrome, the formation of venous and arterial thrombosis. The key mechanism for the development of vasotoxicity is endothelial dysfunction, and anticancer drugs can also affect the processes of thrombosis. The review presents the results of 12 selected observational retro- and prospective studies involving cancer patients receiving presumably vasotoxic therapy. Data on the frequency of occurrence and possibilities for the prevention of vasotoxicity are presented.
{"title":"Vasotoxic Effects of Anticancer Therapy: a Review of Current Data","authors":"Y. Vasyuk, E. Shupenina, A. G. Nosova, E. Novosel, D. Vyzhigin","doi":"10.20996/1819-6446-2023-03-03","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-03-03","url":null,"abstract":"Cardiovascular and oncological diseases are the leading causes of adult death in the world. Despite proven efficacy, anticancer drugs can cause severe cardiovascular complications. Recently, data have appeared on the possible vasotoxic effects of chemotherapy drugs, which can manifest themselves as the progression of arterial hypertension and atherosclerosis, the development of myocardial ischemia and acute coronary syndrome, the formation of venous and arterial thrombosis. The key mechanism for the development of vasotoxicity is endothelial dysfunction, and anticancer drugs can also affect the processes of thrombosis. The review presents the results of 12 selected observational retro- and prospective studies involving cancer patients receiving presumably vasotoxic therapy. Data on the frequency of occurrence and possibilities for the prevention of vasotoxicity are presented. ","PeriodicalId":20812,"journal":{"name":"Rational Pharmacotherapy in Cardiology","volume":"11 42 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79598694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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