This review deals with the necessary and relevant measures for primary and secondary prevention of cardiovascular diseases in Russia. The latest European and American guidelines emphasize that statins are the main class of drugs to be used to improve prognosis. The use of rosuvastatin is justified among the categories of moderate and high risk of developing cardiovascular complications, especially in severe hypercholesterolemia. The use of acetylsalicylic acid is undoubtedly useful for the secondary and, which is more controversial, for the primary prevention of cardiovascular diseases. Over the last few years, major clinical studies on the prevention of cardiovascular, hemorrhagic and oncological complications enable to rely on the expediency of combined, safe use of rosuvastatin and acetylsalicylic acid in individuals over 50 years of age with moderate and high cardiovascular risk. The use of both drugs in one tablet (the original drug Rosulip ASA®, EGIS Pharmaceuticals PLC, Hungary) will significantly increase the compliance with the vital therapy and significantly expand the use of rosuvastatin in clinical practice, which means further reduction in morbidity and mortality from atherosclerotic cardiovascular diseases.

Platelet P2Y12-receptor inhibitors are ranked 2nd in terms of administration frequency among antiplatelet agents (after acetylsalicylic acid). Administration of such drugs is mandatory in conditions characterized by increased activation of platelets, which, above all, include acute coronary syndrome and percutaneous coronary interventions. The use of clopidogrel, the most famous and commonly used today representative of P2Y12 receptor inhibitors, does not always result in reducing a risk of thrombotic complications.The new generation representatives of the of P2Y12 receptor inhibitors (prasugrel, ticagrelor, cangrelor) showed their advantage over clopidogrel in the large-scale studies and are expected to improve the treatment situation not only in patients with acute coronary syndrome and after percutaneous coronary interventions, but also in other high-risk groups.

Prevention of stroke remains one of the most pressing healthcare issues. Acetylsalicylic acid (ASA) is the only antithrombotic drug used for primary and secondary prevention of atherothrombotic stroke. A serious and challenging limitation to extensive antithrombotic therapy in ischemic stroke is the risk of hemorrhagic complications, primarily intracranial hemorrhages. In primary prevention of stroke in individuals without clinical manifestations of atherosclerosis, it is especially important to correlate the perceived benefit and the possible risk posed from the administration of ASA. The combination of ASA with other antiplatelet drugs (dipyridamole, clopidogrel) could additionally benefit some patients after stroke or transient ischemic attack.

Platelet P2Y12-receptor inhibitors are ranked 2nd in terms of administration frequency among antiplatelet agents (after acetylsalicylic acid). Administration of such drugs is mandatory in conditions characterized by increased activation of platelets, which, above all, include acute coronary syndrome and percutaneous coronary interventions. The use of clopidogrel, the most famous and commonly used today representative of P2Y12 receptor inhibitors, does not always result in reducing a risk of thrombotic complications. The new generation representatives of the of P2Y12 receptor inhibitors (prasugrel, ticagrelor, cangrelor) showed their advantage over clopidogrel in the large-scale studies and are expected to improve the treatment situation not only in patients with acute coronary syndrome and after percutaneous coronary interventions, but also in other high-risk groups.

The article tells about the current strategy of secondary prevention of venous thrombosis. The benefits and potential risks of oral anticoagulants are evaluated. The possibility of taking acetylsalicylic acid, if new oral anticoagulants are excluded, is assessed.

The VerifyNow assay is based upon the ability of activated platelets to cross-link beads coated with fibrinogen. However, fibrinogen is an abundant protein of blood, and therefore it may affect test results by competing with fibrinogen of beads for binding to platelets. To test this assumption, we assessed the influence of artificial alteration of fibrinogen level in blood samples obtained from donors (n = 9) and patients on clopidogrel therapy (n = 8) on the results of the VerifyNow P2Y12 assay. Fibrinogen level was altered by adding to blood samples 1/10 volume of fibrinogen solution (10.56 g/liter) or corresponding buffer. Relative to baseline, addition of buffer significantly increased platelet reactivity, whereas addition of fibrinogen decreased it. Analysis of the relationship between change in platelet reactivity values (dBase and dPRU) and change in fibrinogen concentration (dFg) revealed strong negative correlations: dBase =–63.3 × dFg–27.1 (r =–0.924, p < 0.0005) and dPRU =–54.4 × dFg–21.8 (r =–0.764, p < 0.0005). Thus, the results of our experiments suggest that: (i) blood fibrinogen strongly influences results of the VerifyNow P2Y12 assay, and (ii) correcting for fibrinogen effect may be needed to improve the accuracy of the test in the measuring of antiplatelet effect of clopidogrel therapy.

Активация тромбоцитов имеет большое значение в патогенезе развития тром-ботических осложнений атеросклероза. Применение антитромбоцитарных препаратов у пациентов с различными клиническими проявлениями атеросклероза при отсутствии противопоказания является нормальной практикой. Ацетилсалициловая кислота (АСК) рассматривается в качестве «золотого стандарта» ан-титромботической терапии. Однако эффективность АСК у различных больных неодинакова. Частота выявления этого феномена варьирует от 5 до 65%. К возможным механизмам, способным влиять на клинический эффект АСК, относится «остаточная реактивность тромбоцитов», которая может быть ассоциирована с повышенным риском развития сердечно-сосудистых осложнений. В публикации приведены результаты изучения динамики показателей агрегации тромбоцитов и содержания 11-дегидротромбоксана В2 в моче и определения значения «остаточной реактивности тромбоцитов» у больных стабильной ИБС, получающих длительную терапию АСК.

Aspirin is known to be efficient in secondary prevention of atherothrombosis. However, a considerable number of patients despite daily doses of aspirin still experience and suffer from various cardiovascular complications. In the medical literature this phenomenon was described as <>, however, no well-defined criteria for this notion have been developed as yet. The overwhelming majority of researchers take the term <> to mean both inability of the drug to prevent development of secondary thrombotic events, and its failure to adequately inhibit the function of blood platelets according to the findings of various laboratory tests. The incidence of detecting <> varies considerably depending on the pathology involved and the method(s) used, amounting to from 5 to 70% of the cases. Amongst possible mechanisms capable of influencing the aspirin's clinical effect considered (herein, are the following aspects: polymorphism and/or mutation of the cyclooxigenese-1gene, production of thromboxane A2 in macrophages and endothelial cells via cyclooxigenese-2 polymorphism of Ilb/IIIa platelet receptors, competitive interaction with non-steroidal anti-inflammatory drugs for binding with the cyclooxigenese-1 of blood platelets, and platelet activation via other pathways which are not blocked by aspirin.

Effect of isosorbide-5-mononitrate (40 mg/day for 2 weeks) on tolerance to exercise was investigated in 22 patients with ischemic heart disease and stable effort angina in a placebo-controlled cross-over study, Compared to placebo isosorbide-5-mononitrate substantially prolonged time to ischemic ECG changes, increased double product and total work, and decreased number of consumed nitroglycerin tablets (a reflection of quality of life of patients with angina) by 44%, Other effects characteristic of nitrates as a class such as tachycardia and blood pressure lowering were also noted. Some attenuation of antiischemic effect of isosorbide-5-mononitrate occurred after 2 weeks of treatment in 65% of patients however this effect remained to be significant. Complete tolerance to antiischemic action of isosorbide-5-mononitrate developed in 2 patients (12%) while there were no cases of tolerance to hypotensive and heart rate accelerating actions.