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.
It’s commonly known that coronary artery calcification is an independent predictor of the coronary artery disease and high rates of coronary calcium score indicate approximately 10-fold increased risk of coronary artery disease complications in future. In this review, we analyzed publications regarding relationship of atherosclerosis and coronary artery calcification, its diagnosis and risk factors of future cardiovascular events.
The article reviews contemporary diagnosis and treatment of cardiac amyloidosis. Amyloidosis is a group of diseases characterized by deposition of the special protein amyloid or its precursors in organs and tissues. The heart involvement is typical in AL-amyloidosis, secondary systemic amyloidosis, senile systemic amyloidosis, isolated atrial amyloidosis, familial amyloidosis. The article covers the issues of clinical presentation and diagnostic criteria for different types of cardiac and extracardiac amyloidosis. Typical cardiac manifestations of the diseases which may be detected by echocardiography, speckle-tracking echocardiography, cardiac MRI and laboratory diagnostics are discussed in detail. Much attention is paid to etiopathogenetic treatment of different types of amyloidosis. The experience of authors regarding management of cardiac amyloidosis is presented.
In a review these literatures are expounded about the dynamics of prevalence of tobaccosmoking among a population and medical stuff. The role of doctor is presented in a fight against a tobacco epidemic.
This article discusses current understanding of the anatomy, pathophysiology and echocardiographic characteristics of false tendons. False tendons can be found in about half of the surveyed people’s hearts at autopsy. Despite the fact that it took more than 100 years since their first description, the functional significance of these structures remains largely unexplored. It has been suggested that they may inhibit left ventricular remodeling. Some studies have shown that false tendons may reduce severity of the functional mitral regurgitation. False tendons can promote subaortic stenosis and may constitute a morphological substrate of the arrhythmias.
Muscle problems and other adverse symptoms associated with statin use are frequent reasons for non-adherence and discontinuation of statin therapy, which results in inadequate control of hyperlipidemia and increased cardiovascular risk. However, most patients who experience adverse symptoms during statin use are able to tolerate at least some degree of statin therapy. Given the profound cardiovascular benefits derived from statins, an adequate practical approach to statin intolerance is, therefore, of great clinical importance. Statin intolerance can be defined as the occurrence of myalgia or other adverse symptoms that are attributed to statin therapy and that lead to its discontinuation. In reality, these symptoms are actually unrelated to statin use in many patients, especially in those with atypical presentations following long periods of treatment. Thus, the first step in approaching patients with adverse symptoms during the course of statin therapy is identification of those patients for whom true statin intolerance is unlikely, since most of these patients would probably be capable of tolerating adequate statin therapy. In patients with statin intolerance, an altered dosing regimen of very low doses of statins should be attempted and, if tolerated, should gradually be increased to achieve the highest tolerable doses. In addition, other lipid-lowering drugs may be needed, either in combination with statins, or alone, if statins are not tolerated at all. Stringent control of other risk factors can aid in reducing cardiovascular risk if attaining lipid treatment goals proves difficult.
Associated health-related quality of life (QoL) is one of the criteria for assessing the severity of disease in patients with stable coronary heart disease and the efficiency of treatment, including planned revascularization. The main tool of QoL measuring is questionnaire. General questionnaires cover wide range of features common to many diseases. Instead, specific questionnaires are used for a more detailed study of QoL changes in individual nosologies. The determining factors of QoL in patients with stable coronary artery disease are age, sex, sociodemographic factors, clinical symptoms (most often – angina pectoris and/or signs of heart failure), concomitant diseases and conditions, side effects of the treatment, including revascularization. The analysis of impact of coronary artery bypass grafting and coronary stenting versus optimal medical therapy on QoL in patients with stable coronary artery disease is performed at different stages of observation. Indicators of QoL after coronary artery bypass grafting were better at long-term compared to short-term period.