The article reviews contemporary data on role of the coronary artery bypass grafting (CABG) in patients with stable ischemic heart disease. The principles of pre-surgery risk assessment and choice between CABG and percutaneous coronary intervention are provided. Based on the results of the controlled studies, the indications for CABG were established in guidelines. The evaluation of the myocardial viability and coronary reserve may improve patient selection for revascularization procedures. Evidence base regarding predictors of early postoperative complications and results of the long-term observation of patients after CABG is provided. Possible intermediate ctiteria of revascularization efficiency are changes of left ventricular pump function and quality of life parameters. A special attention is devoted to the perspectives of new surgical technologies to improve CABG results.
The review shows the participation of smooth muscle cells, macrophages, bone marrow stem cells in the calcification of arteries, the effect of microcalcifications and diffuse calcium accumulation on the vulnerability of plaque. The relationship between calcification of coronary arteries and such major factors of cardiovascular risk as age, hypercholesterolemia, diabetes mellitus has been clarified. Data on the effect of inflammation on calcium deposition in the vascular wall and the effect of statins on the calcification of atherosclerotic plaques are presented. Assessment of the presence and severity of vascular calcification can significantly improve the accuracy of the diagnosis of atherosclerosis and the prognosis of its course. Calcification mechanisms may be targets for pharmacological interventions, having significant impact on the development and progression of atherosclerosis.
The aim of the study was to determine the possibilities of practical application of electrocardiography (ECG) in the diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) according to the analysis of scientific publications over the past five years in journals indexed by Scopus, Web of Science and PubMed. Analysis has shown that ECG plays an increasingly important role in the diagnosis of ARVD/C. The presence of ECG changes characteristic of the disease (epsilon wave, T wave inversions, QRS complex prolongation in leads aVR and V1) allows diagnosis of ARVD/C in half of the cases without the use of ultrasound and tomography techniques. Electrophysiological disturbances in ARVD/C are registered long before the structural ones. This determines the high value of the ECG for early diagnosis of the disease. The methods of ECG analysis developed in recent years greatly expanded the possibilities of the method in differential diagnosis and prediction of the ARVD/C. The popularization of ECG-methods in diagnosis of ARVD/C among general practitioners is necessary to improve the early detection of such a dangerous disease.
The article reviews the prevalence of cardiovascular diseases (CVD) related risk factors and the level of their control in Ukrainian population on the basis of information from population surveys and State Statistics Service of Ukraine. Factors having major impact on CVD development in Ukraine are hypertension, dyslipidemia, tobacco use, impaired glucose metabolism and type 2 diabetes mellitus, overweight and obesity, unhealthy diet, low level of physical activity and high level of anxiety. In 2015 the prevalence of hypertension in the Ukrainian population amounted to 29735.4 per 100 000, among the working age population – 18521.5 per 100 000, and the total number of smokers reached 6.2 million. Over past decades, some positive trends concerning Ukrainian population awareness of CVD risk factors may be noted. Tobacco use prevalence dropped from 25.6 % to 18.4 % within 2008–2015, there is a better control of hypertension, more physical activity, and more healthy nutrition. Physicians have been identified by The Ukraine national strategy for improving physical activity (2016) as the preferred source of information about physical activity and its impact on the risk of non-communicable diseases. Effective implementation of evidence-based strategies for CVD prevention require state engagement and adequate funding (budgetary allocations) in primary and secondary healthcare.
The review summarizes and analyzes epigenetic changes accompanying cardiovascular complications in diabetes. Data on the participation of epigenetic modifications in pathological changes of endothelial cells, smooth muscle cells and macrophages leading to atherosclerosis are presented. The role of various miRNAs in the differentiation, activation, inflammation, proliferation and migration of vascular cells is described. It has been shown that histone modifications, DNA methylation and miRNA spectrum change participate in the initiation and development of cardiovascular diseases in diabetes, and their study and application of the acquired data has great diagnostic, prognostic, and therapeutic potential.
The aim of the study was to determine the possibilities of practical application of music therapy in the comprehensive treatment of arterial hypertension according to the analysis of scientific publications over the past five years in journals indexed by Scopus, Web оf Science and PubMed. The analysis showed that the main mechanisms of the influence of music on the cardiovascular system are realized through the emotional state and the autonomic nervous system. Depending on the combination of the characteristics of the musical composition (timbre, melody, tonality, harmony, metro rhythm, tempo, dynamics, pitch) it has a stimulating or inhibitory effect on the sympathetic or parasympathetic regulation of the cardiovascular system. Thanks to the ability to ease stress and pathological adrenergic influences, music therapy can reduce heart rate and blood pressure, reduce myocardial oxygen demand, and lower the tone of peripheral blood vessels. Since such hemodynamic effects have a very positive impact on the arterial hypertension, music therapy has a huge potential and should be widely used in practical cardiology.
The sensitivity to warfarin is influenced by genetic factors, which are determined by polymorphisms of the genes CYP2C9 and VKORC1. In case of the wild type – CYP2C9*1, the rate of warfarin metabolism is standard. In the presence of variants of CYP2C9*2 and CYP2C9*3, the activity of the enzyme is reduced, therefore these alleles are «slow metabolizers» and patients need a lower, in comparison with the standard, dose of warfarin. VKORC1 (Vitamin K Epoxide Reductase Complex, subunit 1) is a main enzyme that activates vitamin K. The polymorphisms of VKORC1 can significantly alter pharmacodynamics of warfarin and the requirements for a maintenance dose. Patients with 1639A (rs992323) and 1173T (rs9934438) alleles require lower dose of warfarin (mean dose 24–26 mg/week) compared to 35 mg/week for wild type. While patients with 9041A (rs7294) require a higher dose of warfarin (an average dose 40 mg/week). With timely performance of pharmacogenetic testing it may be possible to identify patients who need an individual dose of warfarin and accordingly to reduce the percentage of complications.
The purpose of the review is to evaluate the available data from fundamental and clinical studies indicating that posttraumatic stress disorder and adjustment disorders are independent risk factors of cardiovascular pathology. Smoking, hypodynamia, alcohol abuse, drug addiction, obesity on the background of behavioral eating disorders partially cause an increase of the cardiovascular risk. The main mechanisms for implementing this association are discussed. The links between mental disorders and diseases of the circulatory system are confirmed by general candidate genes. These factors must be taken into account while assessing personal cardiovascular and mental risks, as well as creating effective preventive and therapeutic measures.
The review summarizes current data on the use of statins in patients with coronary heart disease when performing coronary artery bypass grafting. The information about the mechanisms of action of statins, principles of pre- and postoperative usage, in particular, the duration of administration and dosage, is provided. The beneficial effect of statins in preventing of complications are associated with their non-lipid properties: inhibition of inflammation in the vascular wall, endothelial function improvement, reducing of platelet aggregation and smooth muscle cells proliferative activity. In many clinical trials, statin treatment reduced the risk of postoperative atrial fibrillation, myocardial infarction, stroke and death, allowed to reduce the length of stay in the intensive care and hospital treatment. However, the appointment of high-intensity statin therapy was associated with increased frequency of renal failure. The lack of sufficient evidence base and uncertainty of recommendations lead to insufficient use of these drugs in clinical practice.
The article reviews literature data regarding electronic nicotine delivery systems (ENDS) during 2012–2016. The data of smoking prevalence, frequency of use ENDS in the EU countries, USA and Canada are provided in the article on the basis of 50 sources. The characterics of ENDS and their usage are presented too. The results of the systematic reviews and meta-analyses aiming to study the effectiveness of ENDS in order to stop smoking have been analyzed. The problem of the combined usage of ENDS and tobacco products is discussed in the review. This literature review is very important nowadays as there is no definite opinion about advantages and disadvantages, benefits and danger to health using ENDS.