Acute myocardial infarction is a severe cardiovascular pathology. Recent studies have demonstrated that its clinical course depends not only on the size of necrosis zone, but also on the local inflammation activity. In this study, the dynamics of various cytokines (INF-γ, IL-4, IL-6, IL-8, IL-10, IL-12, and TGF-β) in patients with different clinical course and outcome of acute myocardial infarction was investigated. It was shown that cytokine dynamics is similar to the dynamics of other pro-inflammatory factors. Complicated clinical course of myocardial infarction is characterised by manifested cytokine reaction and delayed normalisation of cytokine levels. In fatal myocardial infarction, IL-6 and INF-γ cytokines are suppressed. The evaluation of cytokine reaction in myocardial infarction patients could be used for predicting the clinical course and outcome of the disease.

The paper focuses on myocardial rupture in acute myocardial infarction, based on the annual reports of Penza City cardiology service (2003-2008) and retrospective medical history analysis of 61 patients, who died in cardiology and therapy departments of city hospitals due to acute myocardial infarction and myocardial rupture. The prevalence, morphological and clinical features of myocardial rupture in acute myocardial infarction are described.

The study was aimed at the evaluation of complex therapy (diltiazem, pioglitazone, and non-pharmaceutical measures) in the correction of anticoagulant, fibrinolytic, and anti-aggregant vascular wall activity among patients with arterial hypertension, metabolic syndrome, and recent ocular vessel occlusion. It was demonstrated that after 4 months of the above-mentioned complex therapy, the anticoagulant, fibrinolytic, and anti-aggregant vascular wall activity was improved, but not normalised. At the same time, the investigated parameters significantly deteriorated if the non-pharmaceutical therapy compliance was low.

Blood levels of osteonectin (a protein marker of stromal stem cells with osteogenic potential) were measured, using the method of biomagnetic protein separation with magnetic microspheres, in 45 men with coronary atherosclerosis and 45 age-matched controls without coronary heart disease. Osteonectin concentration was maximal in men with atherosclerotic stenosis (AS) and calcinosis of coronary arteries. Osteonectin levels were independently associated with several key markers of atherosclerosis, metabolic syndrome, and coronary AS and calcinosis. Therefore, osteonectin could be one of the new markers of coronary AS and calcinosis.

The paper is focused on the problems of cardiovascular risk stratification in women with early oestrogen deficiency (manifested before the age of 45 years). In total, 206 women with various types of oestrogen deficiency (early ovarian insufficiency syndrome, early menopause, ovariectomy syndrome), as well as 50 healthy controls, were examined. The presence of modifiable (arterial hypertension, dyslipidemia, hyperglycaemia, abdominal obesity, smoking, stress) and non-modifiable (early menopause and early cardiovascular disease in mother) was evaluated. Most women with oestrogen deficiency (typically, due to early menopause) had three ort more cardiovascular risk factors.

The paper analyses the results of coronary artery bypass graft surgery cases (n=207), performed in patients with myocardial infarction, severe multi-vessel disease, and left main coronary artery stenosis. The indications for rescue and emergent surgery in early post-infarction angina are specified. The main predictor of early in-hospital mortality was early surgery in the acute phase of myocardial infarction, among patients with left ventricular ejection fraction <30% and cardiogenic shock. In patients with early post-infarction angina and intact left ventricular systolic function, coronary bypass surgery could be performed regardless of the infarction duration.

This 12-week study included 60 patients (age 45-65 years) with metabolic syndrome (MS), chronic heart failure (CHF) of II-III functional class (FC), and recent myocardial infarction. The participants were randomised into two groups (n=30 for each). In the main group, standard CHF therapy was combined with Cardionate 1,0 g/d (meldonium, Makiz-Pharma, Russia). Cytoprotector Cardionate, as a part of complex CHF therapy in MS patients, improved CHF FC and exercise capacity, increased left ventricular (LV) ejection fraction, normalised LV myocardial structure and function, and improved renal function, also reducing insulin resistance severity and improving lipid and carbohydrate metabolism.

Aims: IONA (impact of nicorandil in angina) is a randomised, double blind, placebo controlled trial of nicorandil, with a target dose of 20 mg twice daily. The consistency of benefits seen in subgroups is reported. Methods: The primary composite end point of the study was coronary heart disease death, non-fatal myocardial infarction, or unplanned hospitalisation for cardiac chest pain. Subgroups were defined using baseline characteristics including, age, sex, histories of smoking, diabetes, hypertension, myocardial infarction, revascularisation, anginal status, anti-anginal treatment, other cardiovascular drugs, and an overall assessment of risk. Results: A total of 5126 patients were randomised to receive nicorandil or identical placebo in addition to standard anti-anginal treatment. Overall, nicorandil reduced the incidence of the primary end point from 15.5% to 13.1% (hazard ratio (HR) 0.83, 95% confidence interval (CI) 0.72 to 0.97; p = 0.014). There was no evidence of significant heterogeneity of benefit across all subgroups studied. The absolute risk reduction was greatest and the numbers needed to treat to prevent one event was lowest in subjects at greatest risk. Conclusions: The IONA study demonstrates a significant improvement in outcome by nicorandil treatment across a broad range of patients with stable angina. 

The paper analyses the results of published studies on co-enzyme Q₁₀ effectiveness in patients with arterial hypertension (AH). Co-enzyme Q₁₀ plays an important role in cell energy metabolism, as a co-enzyme and antioxidant. Blood pressure reduction could be explained not only by oxidative stress prevention, but also by improved insulin response to blood glucose elevation. Considering antihypertensive effectiveness and good tolerability of co-enzyme Q₁₀, this medication could be recommended for AH treatment as an alternative agent, or in combination with other antihypertensive drugs. However, to obtain more evidence on the mechanisms of its antihypertensive effect, further studies of co-enzyme Q₁₀ are warranted.

Clinical effectiveness and safety of Propanorm® was studied in patients with arterial hypertension (AH), coronary heart disease (CHD), chronic heart failure (CHF) with intact systolic left ventricular (LV) function, and atrial fibrillation (AF). Effectiveness and safety of Propanorm® was compared to those in Cordarone®. Out of 137 randomised patients, 110 were included in the study (59 in the Propanorm® group, 51 – in the Cordarone® group) and followed up for 12 months. Primary end-points included all-cause mortality, cardiovascular mortality, fatal and non-fatal myocardial infarction and stroke. Secondary end-points included recurrent AF episodes, their duration, AF or decompensation-related hospitalisation rates, systolic and diastolic LF function dynamics during the treatment, and safety profile of Propanorm® and Cordarone® in CHF with intact systolic LF function. The treatment of the main pathology was associated with achieving target blood pressure (BP) levels in 67,3% of the patients, reduction in functional classes (FC) of angina (70%) and CHF (94,5%), and decrease in cardiac decompensation-related hospitalisation rates by 72,9%. After 6 and 12 months of the therapy, Propanorm® effectiveness was as high as 67,4% and 52,9%, respectively, being similar to that for Cordarone® (62,7% and 52,9%, respectively). In 33,9% of the patients, Propanorm® therapy was associated with a reduction in clinical AF symptoms, their duration, ventricular rate during AF paroxysm, and increased number of asymptomatic AF episodes by 30,9%. In cardiac patients, Propanorm® was safer than Cordarone®, with respective incidence of adverse effects of 0% vs. 31,6%. The study PROSTOR is being continued, and the present paper describes the results of 12-month therapy.

Aim: Lercanidipine, a long-acting dihydropyridine with a good antihypertensive efficacy and tolerability. The aim of the ELYPSE trial was to determine the efficacy and tolerability of this medication in daily clinical practice. Methods: Patients with Stage 1-2 essential hypertension, in whom their physicians considered to prescribe a dihydropyridine, were administered lercanidipine 10 mg once daily, with a 3-month follow-up. The study included 9059 patients (mean age 63±11 years; 58% women, 60% over 60 years, 56% with Stage 2 hypertension, and 69% previously treated with other antihypertensive drugs). A subgroup of 1267 patients (14%) experienced adverse reactions, related to pre-administered antihypertensive therapy. Electronic case-report forms and a central Internet database were used for the data collection. Results: Baseline levels of blood pressure (BP) and heart rate (HR) were 160,1±10,2/95,6±6,6 mm Hg and 77,3±9,3 bpm, respectively. Significant reductions in both systolic and diastolic BP were attained at 1 month, with some additional reduction 2 months later. At 3 months, BP level was 141,4±11,3/83,1±6,9 mm Hg, and HR level was 75,2±8,2 bpm (p<0,001 vs. baseline). At the end of the study, 64% of the patients achieved the levels of diastolic BP ><90 mm Hg, and BP control (><140/90 mm Hg) was attained in 32%.><0,001 vs. baseline). At the end of the study, 64% of the patients achieved the levels of diastolic BP <90 mm Hg, and BP control (><140/90 mm Hg) was attained in 32%.><90 mm Hg, and BP control (<140/90 mm Hg) was attained in 32%.><140/90 mm Hg) was attained in 32%. In the subgroup of diabetics (n=1269), adequate BP control (<130/85 mm Hg) was achieved only in 16,4%. The overall incidence of adverse events was 6,5%; the most frequent ones were headache (2,9%), ankle edema (1,2%), flushing (1,1%), and palpitations (0,6%). Withdrawal rate was ><1%. The efficacy and tolerability of lercanidipine in the subgroup of patients included in the study due to adverse events of other antihypertensive drugs were similar to those in the whole study population.><130/85 mm Hg) was achieved only in 16,4%. The overall incidence of adverse events was 6,5%; the most frequent ones were headache (2,9%), ankle edema (1,2%), flushing (1,1%), and palpitations (0,6%). Withdrawal rate was<1%. The efficacy and tolerability of lercanidipine in the subgroup of patients included in the study due to adverse events of other antihypertensive drugs were similar to those in the whole study population. Conclusion: In this study, lercanidipine has demonstrated good efficacy and tolerability in daily clinical practice. These findings are consistent with the results of randomized controlled trials.

The aim of the present work was to review published studies, investigating the dose-related efficacy on blood pressure (BP) of olmesartan and of other commercially available angiotensin II type I receptor blockers (ARBs). Patient population comprised mild to moderate hypertensive adult patients. We selected studies with comparable design and dose ranges. Dose-effect relationship plots were fitted for diastolic (DBP) and systolic (SBP) BP to the simplified Emax model. We also examined controlled studies of olmesartan vs. other individual ARBs. Our overview was based on 7280 patients, of whom 5769 received an ARB, and 1511 received placebo. Except for losartan, the data fitted correctly to the Emax model, with correlation coefficients ranging from 0.77 to 0.99. BP-lowering efficacy defined as Emax was superior with olmesartan, (DBP/SBP, mmHg: -9,0/-12,4) when compared with candesartan (-6,7/-11,3), irbesartan (-6,5/-11,2), and valsartan (-6,3/-8,9). Head-to-head comparisons of olmesartan to each of the other ARBs used at per-label “recommended doses” support the finding of a greater BP-lowering effect of olmesartan. This overview suggests that clinically relevant differences in maximal efficacy, as well as in efficacy of per-label recommended doses can be evidenced among individual ARBs. Olmesartan efficacy was consistently at the highest end of the range of efficacy of ARBs studied.

This review is focused on the main aspects of aspirin therapy in the prevention of various atherothrombosis manifestations and coronary heart disease (CVD). The major mechanism of aspirin action is explained, and additional aspirin benefits, unrelated to its anti-aggregant activity, are described. Clinical groups in need for aspirin therapy, as a part of primary or secondary prevention, are specified, based on the evidence from large clinical trials. The benefits and risks of aspirin therapy are discussed.