Vol 88, No 9 (2016)


Translational medicine in Russian cardiology: a new stage or repetition of the past?

Tereshchenko S.N., Zhirov I.V., Kochetov A.G.


The brief review gives the experience in using the concept of translational medicine in the practical activities of the Russian Cardiology Research and Production Complex in the past 25 years of its existence. It outlines the possible ways of developing this area in Russian medicine to solve crucial scientific and practical tasks.
Terapevticheskii arkhiv. 2016;88(9):5-9
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Role of soluble Fas ligand in myocardial remodeling, severity and outcomes of chronic heart failure

Teplyakov A.T., Berezikova E.N., Shilov S.N., Grakova E.V., Torim Y.Y., Efremov A.V., Popova A.A., Pustovetova M.G., Sabirova A.Y., Kopyeva K.V.


Aim. To reveal the specific features of Fas ligand-mediated ischemic myocardial remodeling and those of chronic heart failure (CHF) development during a 12-month prospective follow-up. Subjects and methods. A total of 94 patients with ischemic CHF were examined and divided into 3 groups according to NYHA Functional Class (FC): 1) FC II CHF in 35 patients; 2) FC III CHF in 31; 3) FC IV CHF in 28. According to the results of the 12-month follow-up, the patients were randomized into 2 groups: A) 49 patients with a favorable course of cardiovascular disease and B) 45 patients with its poor course. Serum soluble Fas ligand (sFas-L) levels were measured by enzyme immunoassay. Results. In the patients with CHF, the baseline sFas-L levels substantially exceeded that in the control group by 3—6 times (p<0.01). In the men with the poor course of CHF, the baseline serum sFAS-L levels (85.94±4.14 pg/ml) were significantly higher than that in the favorable CHF group (107.33±5.13 pg/ml; р=0.0015). ROC analysis of the sensitivity and specificity of cardiovascular risk stratification according to sFAS-L levels revealed the high prognostic value of this marker — ROC-Area±S.E. was 0.75±0.05 (95% confidence interval, 0.60 to 0.81; p=0.0005). There was a statistically significant moderate correlation of left ventricular (LV) ejection fraction with sFAS-L concentrations and a moderate direct correlation between serum sFAS-L concentrations and LV remodeling parameters. Conclusion. The serum level of sFas-L determines the development of ischemic LV remodeling and the severity of CHF, by increasing in proportion to the degree of disease progression. The determination of serum sFas-L levels assists in objectively estimating the severity of apoptosis and may be an important prognostic test to assess the course of CHF in patients with coronary heart disease.
Terapevticheskii arkhiv. 2016;88(9):10-16
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Evaluation of the impact of community-acquired pneumonia on short-term and long-term prognosis in a patient with chronic decompensated heart failure

Polyakov D.S., Fomin I.V., Valikulova F.Y., Vaisberg A.R., Kraiem N.


Aim. To evaluate the impact of community-acquired pneumonia (CAP) on short-term and long-term prognosis in patients hospitalized with signs of chronic decompensated heart failure (CDHF). Subjects and methods. A total of 852 cases were admitted to therapy/cardiology hospital with signs of CDHF during a year. Results. Among the patients hospitalized with signs of CDHF, the prevalence of CAP was 16.5%. This indicator did not depend on the age of hospitalized patients. Among the multisystem disorders, hypertension, different forms of coronary heart disease, diabetes mellitus, and chronic obstructive pulmonary disease were more common in the patients with CAP. The presence of the latter in a patient with CDHF statistically significantly increased the length of hospital stay (13.1 versus 11.9 days; p = 0.009) and also the probability of rehospitalization during a year (odds ratio (OR) 1.9; p = 0.02). The presence of CAP in a patient with CDHF resulted in an increase in mortality rates (OR 13.5; p < 0.001); moreover, the highest risk of a fatal outcome was noted on day 1 of hospitalization (12.7%). During one-year follow-up, the risk of death in patients hospitalized with CDHF and concomitant pneumonia proved to be higher (OR 4.8; p < 0.001) than in those without pneumonia.
Terapevticheskii arkhiv. 2016;88(9):17-22
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Optimizing the prophylaxis of hospital-acquired deep vein thrombosis and pulmonary thromboembolism

Nazarenko G.I., Kleymenova E.B., Payushchik S.A., Otdelеnov V.A., Sychev D.A.


Aim. To reduce the number of preventable hospital-acquired venous thromboembolic events (HA-VTE) and to improve the quality of VTE prophylaxis at multiprofile hospital. Materials and methods. A comprehensive approach to preventing HA-VTE was developed, which involved the global trigger tool method to assess adverse events, as well as the computerized clinical decision support system (CDSS) to prevent HA-VTE on the basis of relevant clinical practice guidelines, and HA-VTE registry. Results. A total of 50 patients (15 men, 35 women; their median age was 70.5 years) with HA-VTE were included in the HA-VTE registry in January 2014 to June 2015. Assessment of a trend in the prevalence of HA-VTE when introducing CDSS to prevent VTE showed its statistically significant decline in the total number of HA-VTE cases (χ2=7.325, df=1; p=0.0068) and in that of HA-VTE in surgical patients (χ2=7.266, df=1; p=0.0070). The statistical significance of χ2 for linear trend was not achieved for medical patients, which is probably due to the small sample size (χ2=2.764, df=1; p=0.0964). While introducing CDSS, there was a statistically significant reduction in the incidence of postoperative VTE from 8.76 to 4.17 cases per 1000 interventions (χ2=5.347, df=1; p=0.0208; the absolute values of HA-VTE and surgical interventions were used for the calculation). Conclusion. The proposed comprehensive approach can substantially increase the detection rate of HA-VTE and decrease its incidence rates. This requires a personified assessment of the risk of VTE and hemorrhage in all hospitalized patients on day 1 of their admission, timely initiation of recommended VTE prophylaxis, and dynamic assessment of the risk of VTE and hemorrhage for timely correction of the prophylaxis.
Terapevticheskii arkhiv. 2016;88(9):23-30
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Lipoprotein(a), its autoantibodies, and circulating T lymphocyte subpopulations as independent risk factors for coronary artery atherosclerosis

Afanasievа O.I., Pylaeva E.A., Klesareva E.A., Potekhina A.V., Provatorov S.I., Afanasieva M.I., Krasnikova T.L., Masenko V.P., Arefieva T.I., Pokrovsky S.N.


Aim. To study the role of lipoprotein(a) [Lp(a)] as a potential autoantigen causing the activation of immunocompetent cells in atherosclerosis. Subjects and methods. A total of 104 men with stable coronary artery (CA) disease and different degrees of progressive coronary atherosclerosis were examined. Clinical blood analysis was carried out and lymphocyte subpopulations (CD4+, Th1, Th17, and Treg) were determined using immunofluorescence and flow cytometry. In addition, the indicators of blood lipid composition, Lp(a), autoantibody (autoAb) titer to Lp(a), and low-density lipoproteins (LDL), and the lymphocyte activation marker sCD25 were also measured. Results. The Lp(a) level was shown to predict the severity of CA lesions (β=0.28, p<0.05), regardless of age, the level of cholesterol, different T-lymphocyte subpopulations, sCD25, and autoAb. A combination of the concentration of Lp(a) above 11.8 mg/dl, that of Th17 over 11.4∙103 cells/ml and the reduced levels of regulatory T cells and IL-10-producing CD4+ T cells showed a manifold increase in the risk of severe and progressive CA atherosclerosis. There was a direct correlation of the blood level of Th1 with that of IgG autoAb specific to all atherogenic apoB-containing lipoproteins, including Lp(a). There was an inverse correlations of the lymphocyte activation marker sCD25 with IgM anti-Lp(a) autoAb titers (r=–0.36; p<0.005), but this was less significant with autoAbs to native and oxidized LDL (r=–0.21 and r=–0.24; p<0.05, respectively). Conclusion. The slightly elevated Lp(a) concentration along with changes in the level of T lymphocyte subpopulations was first shown to significantly potentiate the risk of progressive and multiple CA lesion in the examinees. The correlation of IgM anti-Lp(a) autoAb with the lymphocyte activation marker sCD25 and that of IgG anti-Lp(a) autoAb with Th1 have demonstrated that Lp(a) is involved in the autoimmune inflammatory processes in atherosclerosis.
Terapevticheskii arkhiv. 2016;88(9):31-38
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Budget impact analysis of antiplatelet therapy with ticagrelor and clopidogrel in patients with acute coronary syndrome after coronary artery bypass surgery

Zyryanov S.K., Belousov D.Y., Afanasyeva E.V., Dumchenko E.V.


Aim. Clinical and economic examinations were made to study whether it is appropriate to use antiplatelet therapy (APT) with ticagrelor in combination with acetylsalicylic acid (ASA) versus a combination of clopidogrel and ASA in patients with acute coronary syndrome (ACS) following coronary artery bypass surgery (CABS). Materials and methods. A budget impact analysis was used. Data on the efficiency and safety of APT were taken from a relevant analysis in the subgroups of the randomized controlled trial PLATO. Direct medical cost due to APT and expenses on therapy for acute myocardial infarction, stroke, and massive bleeding, and those on medical care for patients dying from cardiovascular events and other causes, as well as indirect cost - gross domestic product (GDP) losses due to untimely death, were taken into account. The findings were assessed from the perspectives of society. Results. The analysis indicated that direct medical costs per patient following CABS, both in case of calculation based on the recorded price for ticagrelor and on the median registered prices for clopidogrel generics, and based on the auction prices for comparison agents proved to be lower when clopidogrel was administered because of the higher cost of ticagrelor-based APT. At the same time GDP losses due to untimely death, as calculated per patient with ACS during post-CABS therapy with clopidogrel + ASA, were more than twice above average losses per patient taking ticagrelor in combination with ACA (107,122 and 221,645 rubles, respectively). From the registered price for ticagrelor and the median registered prices for clopidogrel generics, the total costs per patient with ACS following CABS were lower if Brilinta was used in combination with ASA versus therapy with clopidogrel in combination with ASA (210,092 and 273,257 rubles per year, respectively; the cost savings were 63,165 rubles per patient per year when ticagrelor was administered). On the basis of the auction prices for comparison drugs, the total costs per patient with ACS after CABS proved to be lower if Brilinta was used in combination with ASA versus therapy with brand name clopidogrel in combination with ASA (201,018 and 293,982 rubles per patients year, respectively; the cost savings were 92,963 rubles per patient per year when ticagrelor was used). Conclusion. The use of ticagrelor in combination with ASA ensures resource savings to treat ACS patients undergoing CABS as compared with a regiment including a combination of clopidogrel and ASA.
Terapevticheskii arkhiv. 2016;88(9):39-49
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Association of the -844G>A polymorphism in the catalase gene with the increased risk of essential hypertension in smokers

Bushueva O.Y., Ivanov V.P., Ryzhaeva V.N., Ponomarenko I.V., Churnosov M.I., Polonikov A.V.


Aim. To investigate whether the functionally relevant -844G>A promotor polymorphism in the catalase (CAT) gene is associated with the development of essential hypertension (EH). Subjects and methods. The investigation enrolled 2,339 unrelated ethnic Russian people, including 1,269 EH patients and 770 apparently healthy individuals. Genotyping of CAT -844G>A (rs769214) polymorphism was performed using a TaqMan real-time polymerase chain reaction assay. Results. The -844A allele (odds ratio (OR)=1.31; 95% confidence interval (CI), 1.04 to 1.64; р=0.02) and the -844AA genotype (OR=1.41; 95% CI, 1.02 to 1.94; р=0.03) were found to be related to a higher risk of EH in the smokers. No association was found between this polymorphism and EH risk in the non-smokers. Conclusion. Smoking is a predisposing factor for development of EH in CAT -844AA genotype carriers.
Terapevticheskii arkhiv. 2016;88(9):50-54
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Analysis of the management of hypertension complications in patients during emergency care

Alpysova A.R., Subbota Y.V., Adambekova A.K., Telembetov N.T., Maratkyzy M.


Aim. To analyze the management of patients with associated complications from hypertension to improve prehospital therapeutic and diagnostic care. Materials and methods. The accounts and records (125,905 calling cards over 2012—2014) of the Statistics Division, Karaganda Regional First Aid Station, were used. The methods of clinical and mathematical analysis were applied. Results. There was an annual increase in the number of calls for all cases of hypertension complications in relation to the higher rate of hospitalization by 2014. The causes of non-100% hospitalization for life-threatening hypertension complications were revealed. Incomplete diagnostic data were one of the reasons for delayed diagnosis and development of prehospital complications from hypertension. When emergency care was rendered, differentiation therapy for hypertension complications was not always withstood; the use of drugs was noted to be unwarranted and contrary to the data of evidence-based medicine. Conclusion. The management of patients with associated complications from hypertension does not fully comply with the Diagnosis and Treatment Protocols of the Ministry of Health of the Republic of Kazakhstan.
Terapevticheskii arkhiv. 2016;88(9):55-58
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Controlled diuretic monotherapy in hypertensive patients: Efficiency and metabolic safety

Semenkin A.A., Zhivilova L.A., Nechaeva G.I., Chindareva O.I., Loginova E.N., Pritykina T.V.


Aim. To evaluate the antihypertensive efficiency and metabolic effects of controlled monotherapy with hydrochlorothiazide (HCT) and indapamide retard (IR) in hypertensive patients. Subjects and methods. The study included 50 patients with Stage II essential hypertension, grades 1-3 blood pressure (BP) elevation, who received 3-month monotherapy with IR (n=25) or HCT (n=25). Changes were determined in BP, blood lipid, glucose, and potassium levels. The efficiency of antihypertensive therapy was evaluated in the entire group and subgroups of patients identified in accordance with the used diuretic and the presence (n=27) or absence (n=23) of therapy at previous stages. Results. A total of 54% of the patients included in the study achieved target BP after 3 months of therapy. The proportion of individuals with normalized BP was comparable in the HCT and IR groups (52 and 56%, respectively) and in previously treated patients and those who used for the first time antihypertensive drugs (51.8 and 56.5%, respectively). Normalization of systolic and diastolic BPs was achieved in 78 and 58% of the patients, respectively. Target BP was achieved in 94,1%, 42,9% and 16,7% of patients with grades 1,2 and 3 hypertension, respectively. IR proved to be metabolically neutral whereas HCT was found to significantly increase the blood levels of triglycerides and glucose by 15.3% (p<0.05) and 12.2% (p<0.05), respectively. Conclusion. Controlled diuretic monotherapy allows BP normalization in more than 50% of the hypertensive patients. HCT and IR have similar antihypertensive efficiency. Because of the negative changes observed in lipid and carbohydrate metabolism with the use of relatively small doses of HCT, IR is a preferential alternative in the long-term treatment of hypertensive patients.
Terapevticheskii arkhiv. 2016;88(9):59-64
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Role of vascular remodeling markers in the development of osteoporosis in idiopathic pulmonary arterial hypertension

Nevzorova V.A., Kochetkova E.A., Ugay L.G., Maistrovskaya Y.V., Khludeeva E.A.


Aim. To define the role of circulating biomarkers for the metabolism of collagen and intercellular substance and vascular remodeling in the development of osteoporosis (OP) in idiopathic pulmonary arterial hypertension (IPAH). Materials and methods. Functional hemodynamic parameters, bone mineral density (BMD) in the lumbar spine and femoral neck and the serum levels of matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1), MMP-9/TIMP-1 complex, C-terminal telopeptide of collagen type 1 (CITP), and endothelin-1 (ET-1) were determined in 27 high-risk IPAH patients and 30 healthy volunteers. Results. OP in IPAH was detected in 50% of the examinees. The serum levels of CITP, MMP-9, TIMP-1, and ET-1 proved to be higher in the high-risk IPAH patients than in the healthy volunteers. There was a direct correlation between BMD and six-minute walk test and an inverse correlation with total pulmonary vascular resistance (TPVR). Serum TMIP-1 levels correlated with cardiac index and TPVR; ET-1 concentrations were directly related to pulmonary artery systolic pressure, cardiac index, and TPVR. Inverse relationships were found between BMD and circulating CITP, MMP-9, TMIP-1, MMP-9/TMIP-1, and ET-1. At the same time, there was only a tendency towards a positive correlation between serum CITP and ET-1 concentrations. Conclusion. The results of the investigation confirm that endothelin system dysregulation plays a leading role in the development of persistent hemodynamic disorders in high-risk IPAH and suggest that it is involved in the development of osteopenic syndrome. Enhanced ET-1 secretion initiates bone loss possibly via activation of connective tissue matrix destruction.
Terapevticheskii arkhiv. 2016;88(9):65-70
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Gender characteristics of the structural organization of sleep in obstructive sleep apnea syndrome

Madaeva I.M., Berdina O.N., Semenova N.V., Grebenkina L.A., Madaev V.V., Kolesnikova L.I.


Aim. To reveal gender characteristics of the sleep structure in obstructive sleep apnea syndrome (OSAS) during polysomnographic monitoring (PSGM). Subjects and methods. According to the results of a pre-survey using an apnea screening questionnaire, the investigation included 58 women (body mass index (BMI), 38.2±2.1 kg/m2) and 75 men (BMI, 34.2±1.8 kg/m2), aged 50—55 years, who complained about snoring, sleep apnea, and daytime hypersomnia. Copy-pair groups were formed and compared after objectively confirming the diagnosis by PSGM made at a specialized sleep laboratory, by applying the GRASS-TELEFACTOR Twin PSG system (Comet) with an integrated SPM-1 sleep module (USA) in accordance with the standard procedure. The International Sleep Disorder Classification (2005) was used to diagnose apnea and to estimate its severity. Results. According to the results of PSGM, the men and women were divided into 3 groups, by using the generally accepted OSAS severity scale. Comparative analysis revealed differences in sleep structure parameters with the equal severity of OSAS in the men and women. These differences were characterized by a more marked fragmentariness, impaired cyclicity, and the appearance of the basic specific phenomenon of impaired integrated activity of somnogenic structures — an alpha-delta sleep phenomenon in the men versus the women. There were increases in the time of rapid eye movement (REM) sleep, in that of awakening at night after falling asleep, and in sleep latency in the women with a simultaneous decrease in the total effectiveness of sleep compared to that in the men with the equal-severity OSAS. Conclusion. The found gender differences in the sleep structure may be ascribed to the compensatory mechanisms in the function of brain somnogenic structures in the women and the preponderance of REM sleep is a compensatory adaptive response of the sleep homeostatic system, which necessitates further investigations in this area.
Terapevticheskii arkhiv. 2016;88(9):71-77
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Nonalcoholic steatohepatitis and biliary sludge in people with metabolic syndrome

Radchenko V.G., Seliverstov P.V., Ledentsova S.S., Manyakov A.V.


Aim. To determine the incidence of biliary sludge (BS) and to evaluate the clinical efficacy of Chophytol in patients with nonalcoholic steatohepatitis (NASH) and BS in the presence of metabolic syndrome (MS). Subjects and methods. Clinical laboratory examination was made in 72 patients with NASH in the presence of MS. BS was identified in 52 (72.2%) examinees who were divided in two (study and control) groups. The efficacy of Chophytol of plant origin, prepared from the purified extract of fresh artichoke (Cynara scolymus) leaf juice, which was used at a dose of 3 tablets thrice daily for a month, was evaluated. Results. The use of Chophytol was established to promote BS elimination in 87% of the patients. This ceased pain syndrome in 87% and dyspeptic manifestations in 65.2% and normalized the levels of lipids and the biochemical indicators of liver process activity. No adverse drug reactions were seen. Conclusion. Chophytol used in patients with HASH and BS may soon be possible to make general condition better, to alleviate the symptoms of diseases of the liver and biliary system, and to appreciably improve the biochemical indicators of blood and bile.
Terapevticheskii arkhiv. 2016;88(9):78-83
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Atrial fibrillation and prolonged nocturnal cardiac arrests in a patient with obstructive sleep apnea syndrome. Successful correction of disorders by CPAP therapy

Bairambekov E.S., Pevzner A.V., Litvin A.Y., Fomicheva O.A.


The case history of a 46-year-old patient with obstructive sleep apnea syndrome was analyzed. The examination revealed fourth-degree obesity, prior myocardial infarction, persistent atrial fibrillation with nocturnal asystoles lasting as long as 14.3 sec. During selected drug therapy and regular application of secondary ventilation (continuous positive airway pressure (CPAP) therapy) used to correct breathing problems, there was a reduction in the signs of circulatory deficiency, cessation of cardiac pauses, and recovery of sinus rhythm. The therapeutic effect persisted during a 24-month follow-up.
Terapevticheskii arkhiv. 2016;88(9):84-89
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Clinical guidelines for the diagnosis and treatment of chronic thromboembolic pulmonary hypertension (Part 1)

Chazova I.E., Martynyuk T.V.


Chronic thromboembolic pulmonary hypertension (CTEPH) is precapillary pulmonary hypertension, in which chronic obstruction of large and middle branches of pulmonary arteries (PAs) and secondary changes in the lung microcirculatory bed result in a progressive increase in pulmonary vascular resistance and PA pressure with the development of severe right cardiac dysfunction and heart failure. CTEPH is a unique form of pulmonary hypertension since it is potentially curable by surgical treatment. The diagnostic criteria for CTEPH are a mean PA pressure of ≥25 mm Hg, as evidenced by right heart catheterization; a PA wedge pressure of ≤15 mm Hg; a pulmonary vascular resistance of >2 Wood units; the presence of chronic/organized thrombi/emboli in the elastic PAs (pulmonary trunk, lobular, segmental, subsegmental PAs); effective anticoagulant therapy at therapeutic dosages over at least 3 months. Up to now, our country has had no guidelines for the diagnosis and treatment of this rare severe disease that, when appropriately untreated, has an extremely poor prognosis. The main task in the preparation of this document was to generalize and analyze the data of current registries, multicenter randomized clinical trials, national and international guidelines, and consensus documents recently published on this problem in order to optimize a diagnostic process and treatment in this category of patients. Part 1 gives a definition of CTEPH, its place in the clinical classification, epidemiology and prognosis, risk factors, pathogenesis and morphology, diagnostic approaches and determination of operability in patients, and specific features of differential diagnosis.
Terapevticheskii arkhiv. 2016;88(9):90-101
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Prognostic value of biomarkers in chronic heart failure with preserved left ventricular ejection fraction

Nikiforova T.A., Shchekochikhin D.Y., Kopylov F.Y., Syrkin A.L.


The paper reviews major biomarkers for determining the prognosis in patients with chronic heart failure and preserved ejection fraction. It also considers cystatin C, one of the novel and probably the most practically important biomarkers.
Terapevticheskii arkhiv. 2016;88(9):102-105
pages 102-105 views

The role of inflammation in the pathogenesis of chronic heart failure

Tokmachev R.E., Budnevsky A.V., Kravchenko A.Y.


The review considers the main points of the concept of progressive chronic heart failure (CHF). The neurohumoral model of CHF pathogenesis could create novel approaches to treating these patients. However, recent studies have shown that the ways of activating the neurohumoral systems in CHF are much more complex. The increased local synthesis of hormones causes the activation of proinflammatory cytokines and proto-oncogenes, which have a number of negative effects. Multiple studies have formulated the immunoinflammatory concept of CHF pathogenesis, according to which the increased concentration of interleukin-6 is a marker of poor prognosis in CHF, and the level of tumor necrosis factor-α directly correlates with the severity of its clinical manifestations and the activity of the neurohumoral background in decompensation. The review gives a classification of cytokines and describes the reasons for their elevated plasma concentration, their possible role in the occurrence and progression of CHF, and their prognostic significance. The pathogenesis of CHF, which includes cytokine aggression, requires further studies of the effect of the inflammatory component on the course of heart failure.
Terapevticheskii arkhiv. 2016;88(9):106-110
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The biological activity of high-density lipoprotein fractions and their role in the development of cardiovascular diseases

Babintseva Y.D., Camont L., Chapman J., Lhomme M., Karagodin V.P., Kontush A., Orekhov A.N.


Increasing the human plasma concentration of high-density lipoproteins (HDL) may be part of strategy for control of cardiovascular diseases (CVD). HDL particles vary in their structure, metabolism, and biological activity. The review describes major HDL fractions (subpopulations) and discusses new findings on the antiatherogenic properties of HDL particles. The whole spectrum of HDL fractions, small, dense, protein-rich lipoproteins, has atheroprotective properties that are determined by the presence of specialized groups of proteins and lipids; however, this activity may be decreased in atherogenic lesion. Comprehensive structural and compositional analysis of HDL may provide key information to identify the fractions that have characteristic biological properties and lose their functionality in CVD. These fractions may be also biomarkers for the risk of CVD and hence represent pharmacological targets.
Terapevticheskii arkhiv. 2016;88(9):111-118
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Assessment of arterial wall stiffness by 24-hour blood pressure monitoring

Korneva V.A., Kuznetsova T.Y.


Arterial wall stiffness is an early marker of cardiovascular diseases. The gold standard for assessment of the stiffness of large vessels is presently pulse wave velocity (PWV). Work is in progress on the study of the reference values of PWV in people of different genders and ages. 24-hour blood pressure (BP) monitoring is not only a procedure that can estimate diurnal BP variability, but also monitor the indicators of vascular wall stiffness in a number of cases over a 24-hour period. The given review highlights the pathophysiology of arterial stiffness, methods for its assessment, and the aspects of use in therapeutic practice.
Terapevticheskii arkhiv. 2016;88(9):119-124
pages 119-124 views

Occupational factors and a risk of cardiovascular diseases

Strizhakov L.A., Lebedeva M.V., Fomin V.V., Muhin N.A.


The paper gives Russian and foreign authors’ data on a relationship between occupational factors and cardiovascular diseases. It considers the impact of psychosocial stress on the risk of hypertension, coronary heart disease, and cardiovascular events in representatives of different professional groups.
Terapevticheskii arkhiv. 2016;88(9):125-130
pages 125-130 views

Dizziness and anxiety disorders in the elderly

Kotova O.V., Zamergrad M.V.


Perhaps each dizzy patient feels anxiety. Varying emotional disorders are particularly common in elderly patients with dizziness. The causes of the frequent concurrence of dizziness and mental disorders (anxiety and depression) are diverse. Amongst these there are two chief conditions: 1) vestibular vertigo may cause anxiety to a greater extent than many other symptoms; 2) anxiety and depression are themselves frequently manifested by the sensations resembling vestibular ones that patients are inclined to call dizziness. On the contrary, anxiety may appear in some cases as the sensations resembling dizziness. Besides the latter, the patient may present a lot of complaints, which serves as a manifestation of psychoautonomic syndrome (the basis for which is anxiety and depression). At the same time, the term «phobic postural instability» is proposed to describe psychogenic disorders, in which dizziness becomes virtually the only chief complaint. The treatment of dizziness and anxiety disorders in the elderly encompasses a few areas: vestibular rehabilitation, drug therapy, and psychotherapy. The paper describes the possibilities of using anvifen as a pathogenetically sound treatment in patients with anxiety disorders, as anvifen is a GABA-ergic medication.
Terapevticheskii arkhiv. 2016;88(9):131-134
pages 131-134 views

Gut microbiota and obesity: Pathogenetic relationships and ways to normalize the intestinal microflora

Drapkina O.M., Korneeva O.N.


The review demonstrates mechanisms in the relationship of obesity to gut microbiota, as well as possible therapeutic measures to normalize the intestinal microflora. There is evidence that the latter makes a great contribution to the pathogenesis of obesity and related diseases. Investigations have shown the role of the nature of consumed foods (fatty foods) in reducing the amount of bifidobacteria and lactobacilli, as well as the effects of bacterial lipopolysaccharides and metabolites from the intestinal microflora (trimethylamine-N-oxide, bile acids, etc.). The use of prebiotics, probiotics and ursodeoxycholic acid preparations and fecal transplantation are promising in correcting the microflora and in providing their positive effect on metabolic disturbances. Certain probiotic strains are effective in treating dyslipidemia, diabetes mellitus, obesity, and metabolic syndrome. Gut microbiota is impaired in obesity and contributes to the development of cardiovascular diseases. The control of the gut microbiota and the use of drugs altering the composition of the microflora may become a novel approach to reducing the risk of cardiovascular diseases.
Terapevticheskii arkhiv. 2016;88(9):135-142
pages 135-142 views

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