CARDIOVASCULAR COMPLICATIONS AND CARBOHYDRATE METABOLISM IN CORONARY SHUNTING “OFF-PUMP” ACCORDING TO THE REGIMEN OF GLUCOSE LOWERING TREATMENT IN ISCHEMIC HEART DISEASE AND DIABETES

Cardiovascular complications of type 2 diabetes mellitus (T2DM) are now a global health problem, due to their main cause of mortality of these patients. Ischemic heart disease (IHD) among all cardiovascular diseases occupies a leading position. The purpose of the study was comparative assessment of possibilities of coronary reserve correction in patients with stable angina and T2DM by nitrates and activator of potassium channels by nicorandil. The study included 54 patients with stable angina of 2-3 functional classes (FC) and T2DM. The dynamics of frequency of angina attacks, mean FC of angina pectoris, exercise tolerance, vasoregulatory function of endothelium under the influence of therapy with nicorandil, isosorbide dinitrate (ISDN) and isosorbide-5-Mononitrate (I5MN) were analyzed. In patients with IHD and T2DM drug of choice for long-term treatment is nicorandil with greater antianginal and anti-ischemic efficacy compared with traditional nitrates. Nicorandil effectively corrects endothelial dysfunction, without causing the development of tolerance and without reducing its effectiveness while taking hypoglycemic therapy.

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Predictor significance of β2-microglobulinuria in determining the risk of cardiovascular complications in patients with chronic ischemic heart disease

Nephrology (Saint-Petersburg) ◽

10.36485/1561-6274-2021-25-6-49-55 ◽

2021 ◽

Vol 25 (6) ◽

pp. 49-55

Author(s):

E. S. Levitskaya ◽

M. M. Batiushin ◽

A. V. Khripun

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Coronary Artery ◽

Ischemic Heart Disease ◽

Unstable Angina ◽

Myocardial Revascularization ◽

Cardiovascular Complications ◽

Ischemic Heart ◽

Chronic Ischemic Heart Disease

BACKGROUND. The relevance of identifying new biomarkers of the cardio-renal syndrome in patients with coronary heart disease is beyond doubt. It is promising to study the indicators of tubular dysfunctions as predictors of the risk of cardiovascular complications in patients without primary kidney pathology.THE AIM. Analysis of the effect of β2-microglobulinuria on the prognosis of cardiovascular complications in patients with chronic ischemic heart disease in the long-term period after myocardial revascularization.PATIENTS AND METHODS. The study included 90 patients with coronary artery disease and indications for myocardial revascularization. Coronary bypass surgery was performed in 64 people, coronary artery stenting - in 26. Clinical and anamnestic data were collected in all patients, standard laboratory and instrumental diagnostics were performed. In addition, the level of β2-microglobulin (β2-MG) in the first morning portion of urine was determined at different study dates. The endpoint was considered to be the presence of acute forms of coronary heart disease - myocardial infarction and unstable angina. Survival after 5.8 ±0.1 years after myocardial revascularization was 69 %.RESULTS. A positive linear relationship of weak strength was established between the level of diastolic blood pressure (DBP) and β2-MG of urine obtained before myocardial revascularization (r = 0.28, p = 0.03). Moreover, the Kaplan-Meyer survival analysis showed the effect of an increase in β2-MG of urine over 0.2 ng/ml on the risk of AMI in the long-term period after myocardial revascularization (p = 0.025). It was found that an increase in the concentration of β2-MG in urine determined before myocardial revascularization is a statistically significant risk factor for the development of unstable angina in the long-term period after RM (χ2-criterion = 7.17, p = 0.007).CONCLUSION. It has been shown that an increase in the concentration of β2-MG in urine, reflecting the presence of tubular dysfunctions, can be considered as a predictor of an unfavorable cardiovascular prognosis in patients in the long-term period after myocardial revascularization.

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Prospects of rivaroxaban application in treatment of patients with chronic ischemic heart disease

Medical Council ◽

10.21518/2079-701x-2019-21-44-50 ◽

2020 ◽

pp. 44-50

Author(s):

N. B. Perepech

Keyword(s):

Heart Disease ◽

Ischemic Heart Disease ◽

Antiplatelet Therapy ◽

Low Dose ◽

Cardiovascular Complications ◽

Ischemic Heart ◽

Chronic Ischemic Heart Disease ◽

Artery Disease ◽

Reduction Of Mortality ◽

Positive Effect

The review is devoted to the analysis of the methods of hemostasis treatment in order to improve the prognosis of patients with chronic ischemic heart disease (IHD). The results of the most significant randomized clinical studies, which evaluated the effectiveness and safety of double antiplatelet therapy in the treatment of patients with chronic IHD, were discussed. The use of rivaroxaban in addition to ASA was justified in order to reduce the risk of cardiovascular events in patients with chronic IHD. The results of the COMPASS study, which confirmed the positive effect on the prognosis of patients with chronic IHD or peripheral artery disease of low-dose rivaroxaban and ASA combination therapy, were reviewed in detail. Safety aspects of this therapy were discussed. The results of double antiplatelet therapy and the combination of rivaroxaban and ASA in patients who had previously undergone myocardial infarction are compared. The position of rivaroxaban in the treatment of patients with chronic IHD and sinus rhythm was determined in accordance with the recommendations of the European Society of Cardiologists for the diagnosis and treatment of chronic IHD in 2019. The criteria of high ischemic and high hemorrhagic risks, which should be taken into account when deciding to add rivaroxaban to the ASA therapy, were presented. The expediency of wide application of the combination of rivaroxaban and ASA as a part of complex pharmacotherapy of patients with chronic IHD with high ischemic risk for prevention of cardiovascular complications and reduction of mortality is justified.

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Depressive disorders in cardiology

Cardiosomatics ◽

10.26442/cs45093 ◽

2014 ◽

Vol 5 (2) ◽

pp. 40-42

Author(s):

A. A Yevsyukov ◽

M. M Petrova ◽

N. P Garganeeva ◽

D. S Kaskaeva

Keyword(s):

Heart Disease ◽

Cardiovascular Risk ◽

Ischemic Heart Disease ◽

Psychosocial Factors ◽

Depressive Disorders ◽

Cardiovascular Complications ◽

Ischemic Heart ◽

Special Group ◽

Rehabilitation Programs ◽

Essential Components

Patients with ischemic heart disease (IHD) with depressive RAS disabilities are a special group of dispensary observation with a higher risk of cardiovascular complications than patients without depression. Timely detection of depressive disorders in IHD patients, the study of psychosocial factors, along with the known factors of cardiovascular risk, are essential components of modern diagnostic, medical and rehabilitation programs for patients with comorbid pathology in the polyclinic.

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New Possibilities to Reduce the Residual Risk in Patients with Ischemic Heart Disease

Kardiologiia ◽

10.18087/cardio.2020.11.n1370 ◽

2020 ◽

Vol 60 (11) ◽

pp. 110-116

Author(s):

L. L. Bershtein

Keyword(s):

Heart Disease ◽

Ischemic Heart Disease ◽

Cardiovascular Complications ◽

Residual Risk ◽

Ischemic Heart ◽

Special Focus ◽

Aggressive Treatment ◽

Significant Progress ◽

Increased Risk ◽

Patients With Diabetes

Despite a significant progress of the recent decades, incidence of cardiovascular complications in patients with manifest, stable ischemic heart disease (IHD) is still high. Furthermore, this patient group is heterogenous; individuals with a higher risk of cardiovascular complications can be isolated from this group based on the presence of comorbidities and acute IHD on the background of the therapy. Such patients require a more aggressive treatment to influence major components of the increased risk. Even after administration of an optimum therapy, the risk for complications in such patients remains high (residual risk). The article discusses the lipid, inflammatory, and thrombotic components of residual risk in IHD patients and possibilities of their control with drugs with a special focus on possibilities of pharmaceutical correction of the risk thrombotic component in IHD patients with diabetes mellitus.

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