A randomized pilot study was performed in coronary heart disease (CHD) patients (ejection fraction, EF, close to 40%; diastolic dysfunction) after primary anterior-septal myocardial infarction (MI), complicated with acute heart failure of Killip functional class II-III, Stage II-III arterial hypertension, and platelet magnesium level <1,2 mkmol/mg of protein. Magnesium deficit in plasma, even without severe hypomagnesimia in serum, impaired endothelial secretion of plasminogen activators, and reduced blood fibrinolytic activity, combined with enhanced platelet secretion of serotonin - inflammatory marker and powerful vasoconstrictor. levels of plasma magnesium and fibrinogen directly correlated ([MgJ = 0,37[fibrinogen] + 0,38; r = 0,67, p<0,02). It could be concluded that severe arterial hypertension combined with magnesium deficit play an important role in platelet hemostasis disturbances and high fibrinogen level resistance towards standard MI treatment.

Holter monitoring results were analyzed in 30 myocardial infarction patients undergoing out-patient rehabilitation. Myocardial ischemia episodes (MIE) were registered in 10 patients (33,3%). In 30% of cases, MIE were silent, associated with mild physical exertion, and low heart rate (HR) levels - 87,2+15,2 per minute. Arrhythmias were registered in all subjects (100%). Fifteen patients (50%) demonstrated high-class ventricular extrasystolia by Lown classification. Supraventricular tachycardia episodes were observed in 31% of cases. Spectral and temporal parameters of HR variability (HRV) were analyzed. Total variation power was reduced, especially in higher frequencies. Centralization index (CI) was increased in most participants (4,14+2,36 units). In 14 patients (46,6%), SDNN was lower than 100 ms. Parasympathic hypotonus was confirmed by declined rMSSD (22,5+8,55 ms) and pNN50% (4,36+3,66 ms). In 60% of cases, circadian index (CI) was reduced (1,19+0,07).

Metabolism of NO, an endogenous vasodilatator, and lipid peroxidation intensity were analyzed in young subjects with normal blood pressure (BP) (<140 mm Hg). In total, 84 male patients aged 18-45years were examined: 32 subjects with optimal normal BP, and 52 - with high normal BP. Comparing to individuals with normal/optimal BP, participants with high normal BP demonstrated increased BP variability and NO synthesis, intensified lipid peroxidation and reduced plasma antioxidant activity (AOA). In high normal BP individuals, higher BP correlated with enhanced NO production, but in longterm BP increase, NO level tended to be reduced. The higher lipid peroxidation intensity was, the lower AOA was registered. In every fourth patient with high normal BP, some abnormalities in vasomotor regulation of vascular tonus were observed.

In 52 male patients (mean age 19,2 years) with Stage I arterial hypertension (risk 0), endothelial function was assessed by Doppler ultrasound of brachial artery at rest, as well as during reactive hyperemia and nitroglycerine tests. Other methods for endothelial function assessment were measuring serum concentration of stable NO metabolites (nitrate, nitrite) - total NO production markers, and investigation of blood pro- and antioxidant activity (malone dialdehyde level, serum antioxidant activity). Compared to control group, impaired endothelium-dependent vasodilatation during reactive hyperemia test and reduced increase in brachial artery diameter were registered. At baseline and one year later, impairment of endotheliumdependent vasodilatation was associated with decreased endothelial NO production. Endothelial dysfunction severity correlated with blood pro- and antioxidant activity dysregulation.

Simvastatin treatment in patients with arterial hypertension (AH) and metabolic syndrome (MS) corrects dyslipoproteinemia, peroxidation syndrome, and optimizes platelet homeostasis. Simvastatin inhibits increased intravascular platelet activity in vivo. For stable correction of metabolism and platelet homeostasis in patients with AH and MS, simvastatin therapy should be long-term. To reduce body weight and insulin resistance in patients with AH and MS, simvastatin could be combined with lifestyle modification.

The study was devoted to dynamics of plasma renin, aldosteron, and lipid profile in patients with primary hypothyrosis and arterial hypertension during hormone replacement therapy and thyroid function compensation. In the phase of hypothyrosis compensation, a significant increase in plasma renin and aldosteron concentration was registered. In subcompensation phase, triglyceride levels were reduced in hypothyrosis without arterial hypertension (AH) in anamnesis; in compensation phase, total cholesterol and low-density lipoprotein cholesterol concentrations were decreased. Among patients with hypothyrosis and AH in anamnesis, total cholesterol and triglyceride levels were reduced in compensation phase, but not normalized.

The study involved 74 patients with coronary heart disease (CHD) (mean age 52,4±4,5 years), with stable effort and exertion angina, Stage II arterial hypertension (in 56% of the participants), and multifocal atherosclerosis in 61% of cases. Among CHD patients without substantial decrease in left ventricular contractility (ejection fraction, EF >45%), activity of antioxidant enzymes increased: for superoxide dismutase (SOD), katalase, and glutathione peroxidase - by 87,5%, 25%, and 34%, respectively. In patients with EF ≥ 35%, SOD and glutathione peroxidase activity increase is also observed (by 198% and 33%, respectively), as well as reduced katalase activity. In participants with EF<35%, pseudo-normalization of SOD activity and reduction of katalase and glutathione peroxidase activity was observed: antioxidant protection system (AOP) potential was decreased (initial, reversible phase). Reduced alpha-tocopherol level was registered only in individuals with EF<35%. Severe IF dysfunction (EF<28%) was associated with AOP activity decrease: by 67% for SOD, by 90% for katalase, and by 74% for glutathione peroxidase. Authors suggest that reduced AOP system reserve in patients with severely impaired LV contractility is one of the most important factors for complication risk, reperfusion (oxidative) and surgery stress.

One of the leading anticoagulants in Russia is warfarin. Its pharmacokinetics is determined by structural polymorphisms of CYP2C9 cytochrome gene, metabolizing warfarin. In the present study, the authors analyzed: 1) prevalence of two allele variants of this gene; 2) patients' individual reaction to warfarin, according to their CYP2C9 genotype. It was demonstrated that: 1) prevalence of CYP2C9 gene allele variants in St. Petersburg population was 82,66% (CYP2C9*1), 11,11% (CYP2C9*2), and 6,32% (CYP2C9*3); 2) individuals with CYP2C9*2 and CYP2C9*3 alleles reached therapeutic hypocoagulation faster, and required significantly lower weekly doses of the medication. Routine identification of CYP2C9*2 and CYP2C9*3 alleles is recommended to all patients administered warfarin.

Examining 81 patients with dilated cardiomyopathy (DCMP) and ischemic cardiomyopathy (ICMP), differential diagnostics criteria were identified. Group I included 45 patients with DCMP (43 males, 2 females), mean age 37,0+2,2 years. Group 2 consisted of 36 patients with coronary heart disease (CRD); mean age 59,3+2,3 years. Together with analyzing anamnesis, clinical data, complication features, instrumental methods were also used: ECG, Hotter monitoring, echocardiography (EchoCG). Cases difficult for diagnostics required endomyocardial biopsy, central hemodynamics assessment, coronaroangiography. In some participants, myocardial scintigraphy with Tl 201 was performed. Left ventricular contractility index (LV CI) was measured in 52 subjects. Thirty-six patients underwent dobutamine stress EchoCG (5-35 mg/kg/min), with assessing IV CI at baseline and after the test. In DCMP, total and local myocardial contractility was more severely impaired, right ventricular (RV) linear sizes were greater, and aorta dimensions decreased. In dobutamine stress test, DCMP and ICMP patients demonstrated contrary LV CI dynamics.

Efficacy, tolerability and cardioprotective properties of rilmenidine were examined in patients with mild to moderate arterial hypertension (AH). The trial involved 51 hypertensive subjects, mean age 57,7+2,5 years. After wash-out period, rilmenidine was administered in the daily dose of 1-2 mg. At baseline and 12 weeks later, blood pressure (BP) and heart rate (HR) dynamics was assessed by the data from 24-hour BP monitoring (BPM), echocardiography, and biochemical blood assay. Good clinical efficacy and tolerability of albarel was observed, without disturbances of lipid, carbohydrate, electrolyte, purin metabolism, functional status of liver and kidneys. Rilmenidine treatment was also associated with EchoCG parameters improvement. Rilmenidine was effective and safe in arterial hypertension treatment, demonstrating cardioprotective properties as well.

Therapeutic effects of a new, super-selective beta blocker with NO-modulating activity, nebivolol (nebilet), on renal functional status in hypertensive patients with Type 2 diabetes mellitus were investigated. After 16 weeks of the treatment, a significant decrease in glycemia and blood pressure levels, serum atherogenity, lipid peroxidation were observed, together with increased basal NO secretion, that resulted in microalbuminuria reduction.

Efficacy and safety of class IС antiarrhythmic agent, propafenone, was investigated in patients with paroxysmal atrial fibrillation (PAF), after single-dose load and during long-term preventive treatment. The study included 20 male and female patients (mean age 53,8+2,4 years). PAF was caused by coronary heart disease (CRT)) and/or essential arterial hypertension. For terminating PAF, a single dose of propafenone, 600 mg, was used. In 75% of cases, the medication was effective. In one patient (6%), long PW, wide QRS, and sinus rhythm deceleration to 48 bpm were observed. These symptoms disappeared without any additional therapy, 4 hours after sinus rhythm being restored. All patients with restored sinus rhythm received 6-month preventive treatment with propafenone (450 mg/d). In 9 patients (60%), there were no recurrent PAF episodes, in 4 (27%) - one PAF episode was registered, in 2 (13%), with BP higher than target levels - two PAF episodes. Extra-cardiac adverse effects of propafenone were not observed. Therefore, propafenone can be regarded as an effective and safe first-line medication for treating PAF. Long-term therapy, together with antianginal and antihypertensive treatment, significantly decreased the number of recurrent arrhythmic episodes.

Intravascular auto-rosette formation in peripheral blood of the patients with acute myocardial infarction was investigated. An association between rosette formation rate and necrosis area size was observed. Among individuals with Q-infarction, autorosette formation was by 1,7times more common than in patients with non-Q myocardial infarction. Increase in auto-rosette number was accompanied with decline in red blood cell and hemoglobin levels.

In 83 patients with sick sinus syndrome and without severe impairment of central/systemic hemodynamics (compensated SSS), decompensation prevention by long-tem atenolol therapy was investigated. Follow-up lasted for 6-24 months, mean atenolol dose was 26,2+3,5 mg/d. In patients with initially decreased heart rate (HR) during pharmaceutical autonomous blockade (PAB) test, treatment was associated with substantial decline in congestive heart failure and chronic atrial fibrillation incidence. Atenolol intolerance was predicted by prolonged sinus node recovery time in baseline PAB test (by 280 sec or more). No significant influence on syncope or pacemaker implantation incidence was observed.

In this article, possible ways of hypercholesterolemia development are analyzed. The authors discuss the role of cell membrane function in cholesterol homeostasis. Taking into account structural and functional stabilization of biomembranes, lipidlowering and pleiotropic effects of statins are analyzed. Association between blood cholesterol level and coronary heart disease (CRT)) prognosis, possibly of indirect nature, is discussed.