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.
Renin-angiotensin system (RAS) antagonists (angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers) are now widely used in the clinical practice. Though arterial hypertension remains the most important indication for these drugs, many major clinical studies showed their organ protecting properties which are not completely dependent on antihypertensive action. They manifest with effective preventing of progressing and even partial regression of target organ damage with pronounced cardio-, angio- and renoprotective action. This served a basis for usage of RAS antagonists in patients after myocardial infarction, at the presence of cardiosclerosis and heart failure. Multidirected action of these drugs is manifested also by their ability to improve metabolic disturbances, especially changes of lipid and glucose metabolism, by prevention of the development and progression of type 2 diabetes mellitus and atherosclerosis. Analysis of the contemporary literature is devoted not only to the description of the RAS antagonists effects but also to the mechanisms of their pleiotropic action which are basis for their therapeutic effects.
The aim of the research is to study the dependence of human health on extreme effects on the human body, being under influence of acute or chronic mental traumatic events. This article reviews contemporary data on the incidence of functional and structural damage of tissues and organs due to stress effects on the body, as well as the feasibility and rationality of the involvement of medical psychologists to work with patients of the general medical profile with borderline mental disorders. New administrative solutions regarding dealing provision of the necessary medical and psychosocial care to patients with stress disorders are provided.
The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study provided extensive data on predisposing factors, consequences, and prevention of atrial fibrillation (AF) in patients with hypertension and left ventricular (LV) hypertrophy. Randomized losartan-based treatment was superior to atenolol-based treatment for reducing new-onset AF and complications, especially stroke, associated with new-onset or pre-existing AF. Potential mechanisms of AF prevention by angiotensin receptor blockade supported by LIFE results include greater reduction in left atrial size and LV hypertrophy. Differential effects of antihypertensive treatment on the left atrium and left ventricle may help prevent AF and reduce risk of stroke associated with hypertensive heart disease.
In the work we analyzed results of the contemporary clinical and fundamental research on the problem of subclinical atherosclerosis diagnosis, predicting of its clinical course and earlier definition of the cardiac endpoints. The results of this analysis allow to conclude that silent atherosclerotic vascular damage is present in the significant part of the middle age population in absence of the traditional cardiovascular risk factors. The vascular calcification is one of the most important and prevalent mechanisms of atherosclerosis, the earliest and significant sign of its presence. Moreover, atherosclerosis is a generalized process. Simultaneous visualization of vessels in different vascular regions allows to improve significantly its diagnostic accuracy, especially in combination with defining existence and severity of vascular calcification. Mechanisms of atherosclerosis determined so far may be a target for medications slowing the progression of atherosclerosis and preventing clinical endpoints.