Drug Treatment in the Prevention of Coronary Artery Disease

1979 ◽  
Author(s):  
J.R.A. Mitchell
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Clinical Trials ◽  
Heart Disease ◽  
Major Part ◽  
Large Scale ◽  
End Points ◽  
Pump Failure ◽  
Artery Disease

The disappointing performance of anticoagulants in the prophylaxis of coronary heart disease led to the realisation that components other than fibrin play a major part in the structure of arterial thrombi. Attention has therefore been focussed on the possible role of agents which modify platelet behaviour. Novel agents which alter thromboxane synthesis will not be available for large-scale clinical trials for some years, so the present trials are assessing the value of platelet-modifying agents which are already in use for other purposes. The implications of the Antura-Reinfarction study and the role of aspirin and persantin will be discussed.Attention will also be drawn to the importance of using valid end-points to assess potential anti-thrombotic regimes in coronary disease. The differential implications of using infarction, sudden death, pump failure, dysrhythmias and re-infarction as end-points in trials will be described.

scholarly journals THE ROLE OF GENE POLYMORPHISMS IN INDIVIDUALLY CHANGING OF THE LIPID PROFILE AMONG PATIENTS WITH CORONARY ARTERY DISEASE UNDER THE INFLUENCE OF THE STATIN THERAPY

2019 ◽  
Vol 42 (3) ◽  
pp. 72-77
Author(s):  
Fushtey I. M. ◽  
Sid E. V ◽  
Litvinenko V. V.
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Lipid Metabolism ◽  
Coronary Artery ◽  
Statin Therapy ◽  
Gene Polymorphisms ◽  
Artery Disease ◽  
Protein Transporters

Ischemic heart disease is one of the urgent problems in modern cardiology, which is associated with a wide spread of disability and mortality mainly among young and employable aged people. The therapeutic drugs effect is individual and depends on the genetic characteristics of the patient. The aim of the study. Analysis of modern literature sources related to the role of gene polymorphisms in individual lipid profile changing among patients with coronary artery disease under the influence of the statin therapy. Literature review. Pharmacotherapy while ischemic heart disease (IHD) provides for mandatory preventive services aimed at the eliminating of modifying risk factors of coronary heart disease. One of the most important indicators of successful treatment of patients with IHD is a lipid metabolism state, that is why treatment can’t be imagined without the inclusion of statins in therapeutic schemes of dyslipidemia correction. The current understanding of the statins effectiveness is based on the knowledge of molecular mechanisms underlying the pharmacokinetics and pharmacodynamics processes. In clinical practice, while taking statins with absolute compliance of patients and elimination of all modifying factors, lipid metabolism parameters are not always normalized, this indicates characteristics of the patients’ genetic. Of particular importance is the effect of genotype on pharmacotherapy using protein transporters, carriers of endogenous compounds or xenobiotics through biological membranes assisted by passive or active mechanisms. Single-nucleotide polymorphisms (SNPs) of transport proteins can change the absorption and excretion degree of drugs and their metabolites. Polypeptides of organic anions membrane transporters that regulate cell uptake of certain endogenous substances and drugs are encoded by SLCO genes. One of the main absorption protein transporters is OATP1B1. It is established that the effects of some SLCO1B1 SNPs on transport function are substrate dependent, and the most studied among them are с.521Т>С and с.388А>G. The c.521Т>C and с.388А>G polymorohisms c.521T>C". Но c.521T>C are in an intermittent contact with each other, and despite this they exist in a variety of SLCO1B1-haplotypes. The c.388А-521Т haplotypes known as *1A ones, c.388G-521Т as *1B, c. 388А-521С as *5 and c.388G-521С as *15. One of the first studies showed that *5 and *15 haplotypes were associated with a decrease in the absorption of statins. In further studies of c.521C allele it was found a related increase of the statins concentration in human plasma, which leads to the progression of undesirable reactions such as myalgia, myopathy, and even rhabdomyolysis, asymptomatic increase transaminase activity and abdominal pain. The study of SLCO1B1 pharmacogenetics found that dysfunction of the protein-transporter leads to reduced absorption by the liver cells, the increasing of plasma concentrations and the change in the body's response to stationery. Conclusion. Analysis of the literature indicates that the therapeutic effect of statins in combination with genetic polymorphisms may have an individual effect on the pharmacokinetics of these drugs. To study the influence of SLCO1B1 c.521Т>С gene polymorphism there are needed the further researches in populations with IHD. A more detailed study of this polymorphism from the perspective of personalized therapy will allow developing individual approaches to the appointment of statins. Keywords: coronary heart disease, statin therapy, gene polymorphism, transporter proteins, personalized therapy.

scholarly journals Microvascular angina: pathogenesis, clinical picture, diagnosis and therapy tactics

2020 ◽  
Vol 4 (7) ◽  
pp. 425-430
Author(s):  
E.N. Shmatova ◽  
◽  
Yu.I. Grinshtein ◽  
◽  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Clinical Picture ◽  
Microvascular Angina ◽  
Diagnosis And Therapy ◽  
Artery Disease

The literature review presents current data on some mechanisms of development, clinical picture, diagnosis, and therapy tactics of microvascular angina (MA). The important role of microcirculatory pathology in the genesis of coronary heart disease is emphasized. Endothelial dysfunction and angiospasm have been shown to be the basis of MA. The article presents MA detection, including the presence of myocardial ischemia in the absence of obstructive coronary artery disease (coronary artery disease <50% or fractional flow reserve >0.80). It was noted that Holter monitoring was not informative for reliable diagnosis of myocardial ischemia, since the results of the study did not exclude or confirm the presence of coronary heart disease, including MA. Stress echocardiography and positron emission tomography were highly informative in the diagnosis of myocardial ischemia caused by microvascular pathology. The article also considers drug therapy tactics with the use of beta-adrenergic blocking agents and calcium channel blockers for patients with MA and the low efficacy of nitrates. The role of second-line drugs such as Nicorandil, Ranolazine, and Trimetazidine is discussed. The important role of statins and angiotensin-converting enzyme inhibitors, which have proven to be effective in the treatment of endothelial dysfunction, is emphasized. Disaggregants, like statins, are an important therapy component of MA.KEYWORDS: microvascular angina, endovascular dysfunction, diagnostics, therapy tactics.FOR CITATION: Shmatova E.N., Grinshtein Yu.I. Microvascular angina: pathogenesis, clinical picture, diagnosis and therapy tactics. Russian Medical Inquiry. 2020;4(7):425–430. DOI: 10.32364/2587-6821-2020-4-7-425-430.

Prediction of atherosclerosis in children and the possibility of early prevention of coronary heart disease

1999 ◽  
Vol 80 (4) ◽  
pp. 296-297
Author(s):  
O. I. Pikuza ◽  
V. N. Oslopov ◽  
H. M. Vakhitov ◽  
A. A. Babushkina ◽  
S. E. Nikolsky
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Cardiovascular Diseases ◽  
Childhood And Adolescence ◽  
Early Prevention ◽  
Cerebrovascular Pathology ◽  
Artery Disease

Cardiovascular diseases caused by atherosclerosis (coronary artery disease, cerebrovascular pathology, etc.) are responsible for 40-50% of all deaths in adults. Of particular concern to clinicians is the emerging unfavorable tendency to "rejuvenate" these diseases. Currently, the fact that atherosclerosis (AS) begins to form in childhood and adolescence is indisputable.

Errors during the exercise test for the diagnosis of Coronary heart disease: negative result in the presence of three-vessel coronary artery disease

2021 ◽  
pp. 30-33
Author(s):  
L. A. Popova ◽  
N. L. Karpina ◽  
M. I. Chushkin ◽  
S. Y. Mandrykin ◽  
V. M. Janus ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Clinical Case ◽  
Multivessel Coronary Artery Disease ◽  
First Choice ◽  
Exercise Ecg ◽  
Artery Disease ◽  
Vessel Coronary Artery

The exercise ECG test is traditionally the first choice in patients with suspected CHD, as the most accessible, despite the fact that its sensitivity and specificity are 68 % and 77 %, respectively. Description of a clinical case of multivessel coronary artery disease in a patient with a negative result of exercise ECG test is presented.

OBSTRUCTIVE SLEEP APNEA / HYPOPNEA SYNDROME IN RAILWAY WORKERS WITH RISK FACTORS FOR CORONARY HEART DISEASE

2021 ◽  
Author(s):  
S. Gorokhova ◽  
◽  
N. Belozerova ◽  
M. Buniatyan ◽  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Obstructive Sleep ◽  
Railway Workers ◽  
Artery Disease ◽  
Step Algorithm ◽  
Hypopnea Syndrome

Abstract: Obstructive sleep apnea/hypopnea syndrome (OSA) is a common condition that may lead to excessive daytime sleepiness, cognitive disturbance, and a decreased concentration that are associated with the risk of workplace accidents and injuries. It is difficult to diagnose OSA due to low severity and specificity of its symptoms and special requirements in respect of medical resources. We assumed that it would be more effective and cost-efficient to diagnose OSA in railway workers with such risk factors f coronary heart disease as arterial hypertension and metabolic disorders since this group receives comprehensive medical attention. However, no studies on the prevalence of OSA in railway workers specifically considered the risk factors for coronary artery disease. The aim of the study was to assess the prevalence of OSA in railway workers with confirmed cardiovascular and metabolic disorders that did not disqualify them from their job. Material and methods. The study included 967 railway workers (locomotive drivers and their assistants). On Stage 1, a group of participants suspected OSA was selected; and on Stage 2, a group of participants with confirmed OSA was formed. Polysomnography or cardiorespiratory monitoring were used to diagnose OSA. Results. We developed a two-step algorithm of OSA diagnosis that included a preliminary assessment of the probability of OSA. 236 (24.4%) participants with a probability of OSA were selected among the initial 967 persons with risk factors for coronary artery disease. Further assessment confirmed OSA in 141 (60%) participants in this group. The analysis of distribution of risk factors for coronary artery disease and OSA showed that 125 (53.0%) of patients with BMI ≥ 30 kg/m², 115 (48.7%) of patients with AH, and 26 (11.0%) of patients with type 2 diabetes had OSA; most of them had some combination of these risk factors. Conclusions: OSA is prevalent in the group of professionally active locomotive drivers and their assistants with risk factors for coronary heart disease; every second worker in a target group with BMI ≥ 30 kg/m², AH or with both risk factors was diagnosed with OSA. The proposed two-step algorithm with a pre-test assessment of OSA probability and subsequent instrumental examination (cardiorespiratory monitoring, polysomnography) allows to accurately diagnosis OSA and allocate medical resources in a cost-effective manner.

scholarly journals Клинический случай гигантской аневризмы правой коронарной артерии

2019 ◽  
Author(s):  
A.L. KOMAROV ◽  
A.YU. FEDOTKINA ◽  
E.V. MERKULOV ◽  
I.V. FEDOTENKOV ◽  
V.M. MIRONOV ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Multivessel Coronary Artery Disease ◽  
Invasive Treatment ◽  
Artery Disease

Представлен клинический разбор больного с ишемической болезнью сердца, многососудистым поражением коронарного русла и гигантской аневризмой коронарной артерии. Рассмотрены возможные подходы к выбору медикаментозного и инвазивного лечения.There was presented a clinical discussion of the patient with coronary heart disease, multivessel coronary artery disease and huge aneurysm of coronary artery. Potential approaches to selecting conservative and invasive treatment were discussed.

Chronic Stable Angina

2017 ◽  
Author(s):  
Benjamin J Scirica ◽  
J. Antonio T. Gutierrez
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Coronary Artery ◽  
Stable Angina ◽  
Chronic Stable Angina ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Artery Disease

By definition, chronic stable angina is angina that has been stable with regard to frequency and severity for at least 2 months. Chronic stable angina is the initial manifestation of coronary heart disease in approximately 50% of patients. Typically, this type of angina occurs in the setting of atherosclerotic coronary arterial narrowing, although other causes are possible. This review covers the epidemiology, pathophysiology, initial evaluation, differential diagnosis, management, and treatment of patients with chronic stable angina. Figures show noninvasive testing and the probability of coronary artery disease; diagnosis of patients with suspected ischemic heart disease; probability of severe coronary artery disease; coronary outcomes for high- versus low-intensity statin therapy; optimal medical therapy (OMT) versus OMT and percutaneous coronary intervention for chronic angina; OMT versus percutaneous coronary intervention for stable coronary heart disease; and coronary artery bypass grafting versus percutaneous coronary intervention for diabetes and coronary artery disease. Tables list the grading of angina pectoris by the Canadian Cardiovascular Society classification system, the differential diagnosis of chest pain, conditions promoting myocardial oxygen supply and demand mismatch, the features of typical angina, the classification of chest pain, a comparison of the pretest likelihood of coronary heart disease (CHD) in low-risk and high-risk symptomatic patients, the posttest probability of significant CHD based on pretest probabilities of CHD and normal or abnormal results of noninvasive studies, survival according to risk groups based on Duke treadmill scores, high- and moderate-intensity statin therapy, revascularization to improve survival compared with medical therapy, revascularization to improve symptoms with significant anatomic (≥ 50% left main or ≥ 70% nonleft main coronary artery disease) or physiologic (fractional flow reserve ≤ 0.80) coronary artery stenoses, and questions recommended by an expert panel for patients with chronic stable angina at follow-up visits. This review contains 7 highly rendered figures, 13 tables, and 109 references.

Echocardiographic wall motion abnormalities in patients with stroke may warrant cardiac evaluation

2019 ◽  
Vol 90 (7) ◽  
pp. 792-795
Author(s):  
Shadi Yaghi ◽  
Andrew D Chang ◽  
Brittany A Ricci ◽  
Brian MacGrory ◽  
Shawna Cutting ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Ischaemic Stroke ◽  
Wall Motion ◽  
Cardiac Evaluation ◽  
History Of ◽  
Wall Motion Abnormalities ◽  
Artery Disease

BackgroundThe aetiology of wall motion abnormalities (WMA) in patients with ischaemic stroke is unclear. We hypothesised that WMAs on transthoracic echocardiography (TTE) in the setting of ischaemic stroke mostly reflect pre-existing coronary heart disease rather than simply an isolated neurocardiogenic phenomenon.MethodsData were retrospectively abstracted from a prospective ischaemic stroke database over 18 months and included patients with ischaemic stroke who underwent a TTE. Coronary artery disease was defined as history of myocardial infarction (MI), coronary intervention or ECG evidence of prior MI. The presence (vs absence) of WMA was abstracted. Multivariable logistic regression was used to determine the association between coronary artery disease and WMA in models adjusting for potential confounders.ResultsWe identified 1044 patients who met inclusion criteria; 139 (13.3%, 95% CI 11.2% to 15.4%) had evidence of WMA of whom only 23 (16.6%, 95% CI 10.4% to 22.8%) had no history of heart disease or ECG evidence of prior MI. Among these 23 patients, 12 had a follow-up TTE after the stroke and WMA persisted in 92.7% (11/12) of patients. In fully adjusted models, factors associated with WMA were older age (OR per year increase 1.03, 95% 1.01 to 1.05, p=0.009), congestive heart failure (OR 4.44, 95% CI 2.39 to 8.33, p<0.001), history of coronary heart disease or ECG evidence prior MI (OR 27.03, 95% CI 14.93 to 50.0, p<0.001) and elevated serum troponin levels (OR 2.00, 95% CI 1.06 to 3.75, p=0.031).ConclusionIn patients with ischaemic stroke, WMA on TTE may reflect underlying cardiac disease and further cardiac evaluation may be considered.

scholarly journals The Role of Traditional Chinese Medicine in the Regulation of Oxidative Stress in Treating Coronary Heart Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-13 ◽  
Author(s):  
Xinyu Yang ◽  
Tianmai He ◽  
Songjie Han ◽  
Xiaoyu Zhang ◽  
Yang Sun ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Antioxidant Treatment ◽  
Molecular Systems ◽  
Artery Disease ◽  
Signal Activation

Oxidative stress has been closely related with coronary artery disease. In coronary heart disease (CHD), an excess of reactive oxygen species (ROS) production generates endothelial cell and smooth muscle functional disorders, leading to a disequilibrium between the antioxidant capacity and prooxidants. ROS also leads to inflammatory signal activation and mitochondria-mediated apoptosis, which can promote and increase the occurrence and development of CHD. There are several kinds of antioxidative and small molecular systems of antioxidants, such as β-carotene, ascorbic acid, α-tocopherol, and reduced glutathione (GSH). Studies have shown that antioxidant treatment was effective and decreased the risk of CHD, but the effect of the treatment varies greatly. Traditional Chinese medicine (TCM) has been utilized for thousands of years in China and is becoming increasingly popular all over the world, especially for the treatments of cardiovascular diseases. This review will concentrate on the evidence of the action mechanism of TCM in preventing CHD by modulating oxidative stress-related signaling pathways.

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