The aim of the study was to evaluate dynamics of heart rhythm variability (HRV during a1, b1, and b2-adrenoblockade by carvedilol in patients with coronary heart disease (CHD) and recurrent angina pectoris treated by endovascular revascularization. The study included 39 men (mean age 57.5 +/- 0.8 years) who underwent stenting of coronary arteries (CA) 6 month or more before the study. For the purpose of analysis, patients with CA restenosis were allocated to group 1 (n = 17), those without restenosis or complaining of chest discomfort in the absence of restenosis during repeated coronaroventriculography comprised group 2 (n = 22). Patients having no complaints were followed up by coronarography 1 year after stenting. HRV was estimated from the analysis of short (15 min) fragments of the standard ECG obtained in the basal state and during a1, b1, b2-blockade by carvedilol (mean dose 22.88 +/- 2.1 mg/day) for 2 weeks. Carvedilol blockade of a1, b1, b2-adrenoreceptors following coronary stenting significantly improved both temporal and spectral components of HRV. This improvement may serve as an independent marker of revascularization efficiency and an earlier predictor of coronary restenosis or reflect progress of the atherosclerotic process in native arteries.

Clinical-hemodynamic and anti-ischemic activity of combined therapy of cardioselective ?1-blocker of the third generation nebivolol (Berlin-Chemie/Menarini Pharma GmbH) having NO-modulating activity with neutral diuretics indapamid (Firm ?Makiz-Pharma?, Moscow) and influence of carbohydrate and lipid exchange were assessed in 38 CAD patients associated with the diabetes mellitus of the 2-nd type. Significant hypertensive and anti-ischemic effects of the combined drugs were noted 12 weeks after. Decreased level of postprandial glycemia and atherogenous dislipidaemia was observed. Marked cardiac-and vasoprotective effects were noted. In the setting of improved microcirculation indices and myocardial mass index regress, left ventricular diastolic function was improved.

The aim of this work was to evaluate anti-ischemic and angiographic efficiency of endovascular revascularization of ischemic myocardium by implantation of Sirolimus-eluting stents from the results of a 18 moth-long prospective study of patients with coronary heart disease and/or type 2 diabetes mellitus (DM). The study included 108 patients with angina of effort randomized into two groups: CHD with DM (n = 51) and CHD without DM (n = 57). All of them received anti-ischemic and antihypertensive therapy and two desaggregants; DM patients also used oral hypoglycemic preparations. The patients underwent implantation of Sirolimus-eluting stents. The frequency of restenosis of the target arteries, development of serious cardio-vascular events (death, MI, cerebral stroke, and the need in repeat revascularization) were compared within 18 months after primary endovascular revascularization. Although Sirolimus-eluting stents markedly improved long-term prognosis in DM patients, results of their implantation were worse than in patients with CHD without DM.

Aim. To evaluate effects of 6-month therapy with losartan in combination with indapamide on a clinical course, immunological, metabolic parameters, left ventricular function, exercise tolerance and quality of life in patients with coronary heart disease (CHD) associated with metabolic syndrome (MS). Material and methods. Forty six CHD patients with postinfarction cardiac dysfunction in MS were randomized into two groups. Group 1 consisted of 22 patients with impaired glucose tolerance, group 2 - of 24 type 2 diabetics. Treatment included combination of losartan (50 mg/day) with indapamide (1.5 mg/day), on demand nitrates, nebivolol. Basic therapy in diabetes included sugar-reducing drugs. Clinical condition, findings of echocardiography, parameters of lipid and carbohydrate metabolisms, immunoglobulins, circulating immune complexes, autoantibodies to cardiolipin (AB to CL), spectrum of proinflammatory cytokines were studied before and 3 months after course treatment. Results. Overactivation of cytokines (primarily IL-2, IL-1, TNFalpha) with high expression of IgA, IgG, CIC, AB to CL was found in CHD patients with type 2 diabetes mellitus and less evident in impaired glucose tolerance. Losartan in both groups had an antihypertensive effect, stabilized LV hypertrophy, improved clinical symptoms leading to cytokines expression decline: TNFalpha by 9.8%, IL-1 - by 6.1%, IL-6 - by 6.7%. Losartan was well tolerated, caused no negative metabolic effects. Conclusion. New original facts of cytokine overactivation and humoral immunity disturbances were discovered which play an essential role in pathogenesis of postinfarction dysfunction and LV remodeling developing in type 2 diabetes mellitus. Losartan 6-month treatment in the fixed combination has a positive effect on clinicohemodynamic and immunometabolic indices. This gives grounds for wider use of losartan in CHD combined with type 2 diabetes mellitus.

Anti-ischemic, cardioprotective, hemodynamic and metabolic affects as well as influence on regress of insulin resistance microcirculation injuries of valtarsan which was used in combination with tiasid diuretics hydrochlortiasid were studied in the secondary prevention of chronic heart failure in patients with left ventricular postinfarction remodeling, ischemic cardiac dysfunction aggravated with the diabetes mellitus of the 2-nd type. The study included 25 patients aged 59,2±5,8 years. Results of 3-months treatment with these drugs revealed their high anti-ischemic and cardioprotective efficacy. The study results showed markedly increased physical tolerance and quality of life of such patients.

The aim of the study was to assess influence of 3-months treatment using selective в1-blocker with additional NO-modulating peculiarities nebivolol, cytoprotector mildronate and their combination on clinical course, intracardiac hemodynamics and quality of life of coronary artery disease patients having chronic heart failure of the II-III functional NYHA class associated with the 2-nd type diabetes mellitus. Improved left ventricular diastolic function was revealed in all patients. The results obtained ground the expediency of including these drugs and their combination in the treatment of patients having ischemic heart disease associated the 2-nd type diabetes mellitus.

AIM:To study safety and effects of nebivolol on the course of coronary heart disease (CHD) and insulin resistance (IR) in patients with diabetes mellitus type 2 (DM-2) after coronary artery bypass grafting.MATERIAL AND METHODS:The study included 53 CHD patients with DM-2 (mean age 56.7 +/- 1.3 years). All the patients were divided into two groups: 22 patients with IR (group 1) and 31 patients free of IR (group 2). All the patients received an 8 week course of nebivolol the efficacy of which was assessed by changes in coronary failure, exercise tolerance, quality of life, lipid and carbohydrate metabolism.RESULTS:In group 1 an antianginal effect of nebivolol manifested with less frequent (by 54.7%) development of angina pectoris (p = 0.0003), a 59.8% (p = 0.0004) decrease in 24-h need in nitroglycerine. In group 2 these reductions were 63.4 and 61.6% (p < 0.01), respectively. Exercise tolerance increased by 36.2 and 25.2%, left ventricular ejection fraction significantly increased by 5.9 and 5%, respectively, quality of life improved by 25 and 23%, respectively. As a result, a functional class of chronic cardiac failure lowered. Nebivolol had no negative effect on compensation of blood lipid and carbohydrate metabolism. A trend to blood insulin fall by 18.4% was found. IR index diminished by 11.9%.CONCLUSION:Administration of nebivolol in a dose 1.25-5 mg/day raised exercise tolerance, improved quality of life, reduced IR index by 11.9%, triglycerides level by 5.3%. This lowered the risk of effects of diabetic atherogenic dyslipidemia.