Given that prolonged exposure to extreme climatic situations may play a role independent of stress factors, influencing the course of the underlying disease, the authors considered appropriate assessment of the effectiveness of additional prophylactic administration of drugs that increase the body's resistance to stress (adaptogens). The purpose of the study - to evaluate the effect of oxidative stress on meldonium, hemodynamics and quality of life of patients with cardiovascular disease (CVD) in extreme climatic conditions (summer heat). The study included 56 patients with CVD aged 38-75 years. Patients were randomized into two groups: active management (M), which in addition to basic therapy during 3 summer months received meldonium (500 mg/day), and control. The following parameters were measured: office blood pressure (BP), blood plasma malondialdehyde (MDA), erythrocyte superoxide dismutase (SOD) activity, level of oxidized low-density lipoprotein. MDA/SOD ratio was calculated. Visual analogue scale was used for assessment of quality of life. Meldonium treated patients demonstrated marked reduction of systolic BP and heart rate during heat, increased sodium level at the 2nd visit, improved quality of life. These changes corresponded to adaptive responses of healthy men. No significant dynamics of these parameters occurred in control group. MDA level during heat increased in both groups (p<0.05) but MDA/SOD ratio, which characterizes the "oxidation potential" of blood, increased significantly during the summer heat only in the control group. Meldonium can be used as an adaptogen in CVD patients during the summer heat.

AIM:To evaluate the impact of intake of cardiac drugs on adaptation to abnormal heat in patients with cardiovascular diseases (CVD).SUBJECTS AND METHODS:The study covered 188 patients with CVD, who had visited the Research Dispensary Department in January 2011. General clinical examination, biochemical blood analysis, and electrocardiography were made; the hospital anxiety and depression scale, the visual analog scale, and the questionnaire specially developed for this investigation were used. The authors considered acute myocardial infarction, acute stroke, hospital admission, a medical emergency team call, temporary disability (days), hypertensive crises, and unplanned visits to a doctor as estimated outcomes (endpoints) and the number of undesirable reactions a week during the abnormal heat and from September to December 2010 as a combined endpoint.RESULTS:There were a larger number of weekly adverse reactions than usual and a reduction in quality of life (QL) during the abnormal heat. Both an increase and a reduction in the dose of cardiac drugs during the abnormal heat were associated with its worse tolerability. The use of angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers (CCB) was an independent factor associated with the smaller number of complications during the abnormal heat. That of diuretics was an independent factor that was associated with a more decrease in QL in elderly patients during the heat. The intake of angiotensin receptor blockers (ARB) or nitrates was an independent factor associated with the larger number of complications during the abnormal heat.CONCLUSION:The use of ACE inhibitors and CCB is associated with fewer complications during the abnormal heat of 2010. The intake of diuretics in patients over 65 years of age and that of ARB or nitrates was associated with worse heat tolerance.

Aim of the study was to investigate relationship between the presence of a drug in the list of supplementary drug provision (SDP) and compliance to its consumption by outpatients with arterial hypertension as well as determination of the place of SDP in a row of other factors affecting compliance to treatment. Methods. Patients (men and women) older than 18 years with initial level of office systolic arterial pressure (AP) 140-179 mm Hg and diastolic AP up to 100 mm Hg who visited regional internist. The study was conducted at the base of 82 Moscow polyclinics with participation of 185 physicians and 5474 patients. In all patients besides general clinical examination with office AP measurement calculation of body mass index and assessment of risk factors and concomitant therapy were carried out. All patients assessed themselves their self feeling with the use of visual-analog scale (VAS). Compliance of patients to antihypertensive therapy was evaluated with the help of the Moriski - Green test. Fact of continuous use of antihypertensive drugs received by patients within framework of the SDP system was necessarily obligatory. For final analysis 4816 ambulatory cards were selected. Results. Portion of patients with low compliance to therapy was greatly than that of patients with high compliance to therapy (61.1 vs. 38.9%, respectively, p=0.00001). Inclusion into analysis of additional factor (presence of CHD) reduced contribution of SDP to compliance to 25%, but it remained as before significant (p<0.0007). However addition to these factors of other parameters such as presence of diabetes mellitus or tonometer at home completely leveled effect of SDP on compliance to therapy (p<0.12). Conclusion. Presence of drugs in the SDP list significantly elevates compliance to therapy. However SDP does not appear the only independent predictor of high compliance. If SDP is considered together with other determining factors (presence of concomitant IHD and diabete, readiness to spend money for tonometer) its role as independent factor of high compliance is diminished and loses significance.

Aim. To compare the effects of ACE inhibitors zofenopril and perindopril on endothelial function and oxidative stress (OS) in patients with stable CHD and AH. Material and methods. In total, 40 patients with stable CHD (Functional Class II-III effort angina) and Stage 1-2 AH received zofenopril (7,5-30 mg/d; mean dose 18,6±8,8 mg/d; n=17) or perindopril (2-8 mg/d; mean dose 4,1±2,1 mg/d; n=23) for 12 weeks. At baseline and in the end of the study, all patients underwent reactive hyperemia test (RHT), to assess flow-dependent vasodilatation of brachial artery, and the measurement of OS parameters (malone dialdehyde, MDA, in low-density lipoproteins, MDALDL) and antioxidant parameters (superoxide dismutase (SOD) and glutathione peroxidase (GPO) activity in erythrocytes). Results. In both groups, a similar reduction in systolic and diastolic blood pressure levels was observed. In the zofenopril group, a significant elevation in brachial artery diameter increase during RHT, a significant increase in GPO activity, and some reduction in MDALDL levels were observed, which points to antioxidant system (AOS) activation and OS reduction. No similar changes of these parameters were observed in the perindopril group. Conclusion. In patients with stable CHD and AH, zofenopril, but not perindopril, reduced OS severity and increased AOS system activity, which was associated with improved endothelial-dependent vasodilatation.

With the aim to assess effect of arterial wall stiffness on prognosis of patients with stable form of ischemic heart disease (IHD) we included 224 men (mean age 56.2+/-8.9 years) with confirmed IND in a long-term prospective study. Pulse wave velocity was measured with brachial-ankle method (PWVba), presence of left ventricular hypertrophy (LVH) was detected with electrocardiography. Coronary arteriography was carried out in 126 patients. During 3.5 years of follow-up there were 38 cardiovascular complications (CVC) (6 myocardial infarctions, 19 operations of revascularization, 11 hospitalizations because of unstable angina, 3 sudden deaths). Patients were distributed to groups (tertiles) depending on PWVba values. Elevation of stiffness of arteries from lowest to highest tertile was significantly associated with increases of age, level of arterial pressure, heart rate, level of total cholesterol, LVH, severity and extent of coronary atherosclerosis. The Cox model of proportional risks comprising 14 main risk factors allowed to reveal that only PWVba significantly (<0.001) contributed to formation of prognosis. In patients with PWVba exceeding 14.3 m/s (highest tertile) compared with those with PWVba below 12.4 m/s (lowest tertile) risk of development of CVC was 4.23 times higher (5.27 times higher after adjustment for age and systolic arterial pressure). Comparison of Kaplan-Maier survival curves confirmed that in patients with low PWVba cumulative probability of absence of CVC was greater than in patients with higher stiffness of arterial wall (<0.008). PWVba as marker of arterial stiffness in men with chronic course of IHD appears to be predictor of CVC independent on age and classic risk factors.

AIMArterial stiffness is a predictor of atherosclerosis. This study was conducted to develop a method of coronary atherosclerosis severity assessment by means of brachial-ankle pulse wave velocity (baPWV).MATERIAL AND METHODSWe measured baPWV in 119 males (age 51.67 +/- 7.25) who received coronary angiographic examination (CAG). The baPWV was measured by Vasera VS-1000 (Fukuda Denshi).RESULTSThe patients were divided into two groups by severity of stenosis (group 1--less than 50% stenosis, group 2 > 50%). The baPWV value was significantly greater in group 2 (n = 98, baPWV 13.15 +/- 2.14 m/s, p = 0.004) than that in group 1 (n = 21, baPWV 12.13 +/- 1.17 m/s). ROC-curve demonstrated that the best cut-off point of the baPWV for predicting occlusive atherosclerosis was 12.2 m/s. The area under ROC-curve was 0.66 (p = 0.034). An univariate binary logistic regression model demonstrated that only baPWV had a significant odds ratio for coronary stenosis > 50%: 2.68 (95% CI = 1.01-7.15), p = 0.043. Other risk factors were not significantly associated with severity of stenosis.CONCLUSIONThe baPWV significantly reflects the severity of stenosis in middle-aged males opening new perspectives of noninvasive detection of coronary artery atherosclerosis in middle-aged males.

Introduction into clinical practice of transradial coronary angiography (CA) made it possible to conduct the procedure in outpatients and thus increase number of CA and diminish its cost. Aim of the study was to assess possibility, safety and economical efficacy of outpatient CA. Between April 2004 and August 2007 CA was carried out in 133 outpatients without overt heart failure, unstable angina, complex disturbances of cardiac rhythm or conduction. Comparison group comprised 187 patients subjected to CA within framework of short term hospitalization program. There were no complications associated with the use of either transradial or transfemoral approach. Total average cost of outpatient CA was 19% less than that of inhospital CA. Thus outpatient CA with transradial approach appears to be safe and effective procedure with low risk of complications in patients with stable ischemic heart disease.

Thirty patients with grades 1-3 arterial hypertension were examine to evaluate in patients with arterial hypertension the effectiveness and safety of treatment in patients with angiotensin-converting enzyme (ACE) inhibitor enalapril and the thiazide-type diuretic chlortalidone and to study the impact of this therapy on the great arteries. This combined therapy could reduce systolic blood pressure (BP) from 166,9 ± 22,8 to 135,7 ± 14,1 mm Hg, diastolic BP from 101,8 ± 22,8 to 135,7 ± 14,1 mm Hg (p