The review article provides data on prevalence of the chronic renal disease in the world and in the Russian Federation, major growth factors of persons with chronic renal disease (CRD). Special attention is focused on criteria of early CRD diagnostics and modern approaches to deceleration of progression rates based on results of key international clinical studies. A justification of the strict control of the arterial pressure and application of the antihypertensive agents affecting rennin-angiotensin-aldosterone system for the purposes of nephroprotection is demonstrated.

A clinical case of the arterial hypertension in combination with migraine is considered in a woman of a reproductive age. The tactics of the antihypertensive therapy is discussed from the point of view of therapy of arterial hypertension and prevention of cardiovascular diseases and prevention of migraine attacks. Existing recommendations on prevention of cardiovascular and cerebrovascular diseases in women are analyzed and an algorithm of the drug therapy based on the available data about the general nature of pathophysiological mechanism of development of arterial hypertension and migraine is provided.

Treatment of arterial hypertension (AH) despite the large variety of antihypertensive drugs currently remains one of the most urgent problems in modern cardiology. However, the scheme used in clinical practice does not always correspond to existing recommendations, in particular, of the European Society of Hypertension, ESH, and the European Society of Cardiology, ESC. Thus, patients with 2–3 degree increase blood pressure (BP) and high or very high added risk often do not get the combination therapy that is required for them in this clinical environment. According to the recommendations of the ESH and ESC patients with hypertension of low/medium risk of development of cardiovascular complications (CVC) and death from them a monotherapy can be prescribed if targeted AP values are achieved [1]. Patients with high or very high risk of CCO and/or AG of Degree 2 and 3 immediately must be prescribed a combination of the two drugs. If the target blood pressure values are not attained, either a combination of two drugs at the maximum therapeutic doses, or replacement of the combination of drugs is prescribed or the 3d, 4th and so on antihypertensive drug is added [2, 3]. Combination therapy may also be administered to patients with hypertension with low/medium risk of development of CVC if the target AP are not reached [3, 4].

The review describes mechanisms of action of metabolic myocardial cytoprotectors and recommendations on their use within the pharmacotherapy of stable ischemic heart disease. On the basis of results of clinical studies devoted to study of the trimetazidine effectiveness indications of use are specified and a therapeutic niche of this drug in therapy of patients with ischemic heart disease.

It has been studied the efficiency of ethylmethylhydroxypyridine succinate in patients with angina FC II, depending on the level of anxiety. There was high positive correlation between the number of angina attacks and high level of anxiety in patients with angina FC II. Also, there were some special effects of ethylmethylhydroxypyridine succinate as quantity of attacks, blood pressure level, and the frequency and nature of cardiac arrhythmias, heart rate variability, life quality and, as a consequence, frequency of seeking care.

The prospective randomized study of the efficacy and safety of antianginal therapy with a combination of bisoprolol, ivabradine and trimetazidine or ranolazine included 107 patients aged 60 to 79 years with coronary heart disease and angina of effort of functional class II-IIIs. If the angina and/or myocardial ischemia sine dolore in patients receiving bisoprolol and ivabradine after randomization was additionally administered Trimetazidine (35 mg 2 p/day, n = 54) or ranolazine (500 mg 2 p/day, n = 53). Within 6 months both the treatment was well tolerated, significantly improved the results of treadmill exercise test, systolic and diastolic functions of the left ventricle, the structural and functional state of large arteries, quality of life of patients. Trimetazidine largely reduced the duration of painless depression of the ST segment according to Holter electrocardiogram. Combination of low-dose beta-blocker with ivabradine and trimetazidine or ranolazine can be used for the treatment of refractory stable angina in patients of elderly and senile age.

The author describes the modеrn principles of management and medical treatment of stable coronary heart disease, are given characteristics of the main groups of medicines, the possibility of pharmacological treatment IHD. Angina pectoris can be effectively treated with the appropriate use of available antianginal drugs in addition to lifestyle modifications. The choice of antianginal drugs should be tailored to the individual’s blood pressure and heart rate, and existing co-morbidities, in addition to the side effect profile of the drug. Patients with angina pectoris due to coronary artery disease should also be treated with low-dose aspirin and a statin.

The review summarizes current knowledge regarding the origins and role of myocardial fibrosis formation, including the effects of humoral and cellular components. The concepts of extracellular matrix and volume, their clinical significance for the progression of cardiovascular diseases, the background for the formation of new approaches for the treatment of cardiac pathology are considered, taking into account the results of determination of extracellular volume with the help of MRI.

The review article on the basis of recommendations of the European Society of Cardiology and results of clinical and register studies reported at the European Society of Cardiology Congress 2017 discussed difficult issues arising in prescription of anti-thrombotic therapy to patients with acute coronary syndrome, as well as with the concomitant atrial fibrillation; perspective strategies of ischemic and hemorrhagic events risk management are described; results of studies evaluating effectiveness and safety of acute coronary syndrome patients transfer from new antithrombotic agents to clopidrogel are provided.

Objective: To assess the effect of left ventricle reconstruction in patients with postinfarction aneurysm on remodeling and heart failure dynamics in the immediate and long-term postoperative period. Material and methods: 162 patients with IHD who underwent myocardial infarction and chronic left aneurysm were included in the study. All the patients underwent myocardial revascularization and reconstructive intervention in the LV cavity at the National Medical Research Center named after V.А. Almazov. Two groups of patients were formed, depending on the type of surgical intervention performed. Group 1 (n = 116) included patients who underwent linear plastic surgery of the left ventricle aneurysm. Group 2 (n = 46) identified patients who underwent an intraventricular plastic aneurysm of V. Dor. Results: In the early postoperative period, a statistically significant decrease in the volume of the LV cavity was observed and the global ejection fraction changed in both study groups. In patients with a significant degree of mitral insufficiency additionally did the plastic fibrous ring. The conducted single-factor analysis showed a statistically significant effect of correction of mitral insufficiency on CDD, DAC, and global ejection fraction. The majority of patients in both groups experienced a decrease in LV volumes in the long-term period. Predictors of unfavorable clinical course of heart failure in the long-term period were revealed: violation of contractility at the level of basal parts of the left ventricle with a decrease in the index of violation of local contractility more than 3, ejection fraction less than 35%, uncorrected mitral insufficiency II and more, increased level of natriuretic peptide 4 times from the upper limit of the norm. Conclusions: Combined operation makes it possible to improve the contractive function of left ventricular, to reduce the degree of mitral insufficiency, the functional class of heart failure.

The article discusses modern approaches to the treatment of atherogenic patients, provides data on the effectiveness of new hypolipidemic drugs and discusses the role of intensive statin use regimes at the modern stage of the lipid-lowering therapy. Evidence is provided on the effectiveness of the use of rosuvastatin to reduce blodo LDL-cholesterol and to reduce the risk of cardiovascular disease complications caused by atherosclerosis.

The article deals with the management of patients with dislipidemias and modern approaches to their treatment. The role of pharmacological and nonpharmacological treatments, as well as new groups of drugs for correcting lipid violations were considered in detail. The role of PCSK9 inhibitors in primary and secondary prevention of dyslipidemias was noted.

The article is devoted to the innovative drug to treat chronic cardiac insufficiency – a combination of sakubitril neprilysin inhibitor and first type angiotension II receptor antagonist valsartan (sacubitril/valsartan). Study results are provided in which a combination of sacubitril/valsartan demonstrated effectiveness in patients with arterial hypertension as well as with cardiac insufficiency. Advantages of a combination of sacubitril/valsartan as compared to other drugs affecting components of rennin-angiotension-aldosteron system from the point of view of safety and effectiveness in patients with cardiac insufficiency are demonstrated.

This article discusses the relevance of the high mortality of cardiovascular diseases (CVD) and their complications. Provides an overview of research conducted in the field of treatment of chronic heart failure and other cardiovascular diseases. In treatment notes medications that possess cytoprotective effects that affect cellular metabolism, ionic homeostasis, structure and function of membranes. Proved the feasibility of the introduction of Meldonium in the complex therapy of patients with CHF.

The analytical article provides a modern state of the anticoagulant therapy in pulmonary thromboembolism. Major advantages and preferential use of direct selective peroral anticoagulants represented by thrombin inhibitor dabigatran and a Xa factor inhibitors composed of apixaban, edoxaban and rivaroxaban. Attention is focused on rivaroxaban the evidence base of which in pulmonary thromboembolism was widened in 2017 by data of the EINSTEIN CHOICE study. Its results allow considering the use of the rivaroxaban 10 mg 1 time per day as a possibility of long-term, actually many year prevention of the pulmonary thromboembolism after the end of the standard course of the therapeutic anticoagulation involving use of a high dosage of the drug (15 mg 2 times per day) for 3 weeks actually from the moment of the disease diagnostics and continuation for 6-12 months of the drug administration at a dose of 20 mg 1 time per day. As a result for many patients with pulmonary thromboembolism use of rivaroxaban at various dosages without transfer to another coagulant allows considerably satisfying the requirements in antithrombotic therapy at various stages of such patients management.

Since 2011, with the emergence of new classes of antithrombotic drugs – inhibitors of the activated X coagulation factor (rivoroxaban, apixaban, edoxaban) and thrombin inhibitor (dabigatran), antithrombotic therapy has received a new impetus to development and wider introduction into practice. New oral anticoagulants (NOAC) do not require laboratory monitoring for correction and dose selection, which makes their appointment more simple and convenient, compared with vitamin K antagonists (warfarin). The purpose of the presented work was to evaluate the efficacy and The safety of anticoagulant therapy in patients with atrial fibrillation in out-patient practice. The study was conducted for 1 year. There were 168 patients (108 men, 60 women, mean age 70. 6 ± 2.46 years) with atrial fibrillation. 90 patients received PLA (53% – dabigatran, 41% – rivaroxaban, 6% – apixaban), 78 – warfarin. 74% of patients included in the study had 3 or more points on the scale CHA2DS2-Vasc. During the observation period in the PLA group, ONMC was registered in 2 patients (2.2%), PE – 0. In 1 patient, embolism in the brachial artery was observed against the background of anticoagulant withdrawal due to the planned surgical intervention. In the group receiving warfarin as an anticoagulant, 2 strokes were registered during the year (2.3%) (1 of them fatal). The frequency of bleeding in the PLA group: large – 0, macrogematuria – 3, nasal 2, conjunctival – 2. In the warfarin group: large – 1 (fatal stratification of the aneurysm of the abdominal aorta), macrogemaria – 4, nasal 1, conjunctival – 1. Reliable differences in The frequency of bleeding was not revealed.

Rational balance between risks of bleeding and risks of thrombosis is cornerstone of modern antithrombotic therapy. Regulation of haemostasis has no any physical signs. In a case of bleeding careful management is of great importance. Abrupt discontinuation of antithrombotic therapy is associated with some degree of thrombosis risk. Problems of re-initiation of antithrombotic therapy in CAD patients after bleeding are discussed.

Treatment of chronic obliterating peripheral arterial disease (PAD) and the resulting chronic ischemia of the lower extremities is at the moment one of the most urgent problems in vascular surgery. According to recent reports, the prevalence of PAD has already reached the pandemic: in 2010, there were more than 200 million people suffering from PAD, including more than 40 million in Europe and over 14 million in North and South America. This disease is rarely found in patients younger than 40 years, but one person out of every 10 people aged 70 years or older and every sixth person at the age of 80 years or older suffers from it [1]. In the United States, there are more than 8.5 million people suffering from this disease. In this country among people older than 55 years 10% have an asymptomatic form of peripheral arterial diseases and 5% suffer from intermittent claudication (IC) [2]. In Russia, from 15 to 30% of the population older than 65 years have signs of obliterating diseases of lower limb arteries [3,  4]. In 2013, in 44 regions of Russia 173 883 new cases of PAD were registered, which given the high prevalence of asymptomatic forms of the disease (more than 2/3 of patients are asymptomatic) suggests that the number of this group of patients in Russia exceeds more than 1.5 million people.

Long-term (indefinitely long) use of oral anticoagulants is the most efficient method of medical prevention of cardioembolic complications of atrial fibrillation (AF). This approach is superior to the effectiveness of antiplatelet agents (as monotherapy by acetylsalicylic acid and its combination with clopidogrel). This summary will present the facts that determined ideas about the place of one of the oral anticoagulants of direct action – rivaroxaban – in the prevention of cardioembolic complications in patients with non-valvular atrial fibrillation. We are talking about a randomized, controlled study ROCKET AF, the results of which became the basis for the approval of rivaroxaban for widespread use in non-valcular atrial fibrillation.

Personalized medicine appeared about three decades ago. Even then many scientists, researchers, doctors were interested into it. However, only after the full opening of the human genome in 2001, personalized medicine could to give the opportunity for some pathologies (oncology, rheumatology, cardiology) to choose the most effective treatment with minimal adverse drug reactions for a specific patient. The opportunity to own genetic information gives the chance to suspect, to predict, to expect the onset of the disease. Personalized medicine is able in some cases to say exactly whether the drug can work for the patient, moving us to «treat not a disease, but the patient.» But doctors to this day when determining risk factors focus on individual characteristics of the patient, such as age, gender, body weight, co-morbidities, and based on that prescribe medications, correct dose and in case of ineffectiveness change the treatment regimen. Apparently they don’t believe in personalized medicine, afraid of it and I don’t want to associate with it, because as many think on the basis of their experience and knowledge they can decide which drug and what dose to prescribe. Also, there are a number of reasons related to privacy, security, problem of training, which will soon need to be addressed.

Growth of a population of patients with diabetes and the frequency of its chronic complications-some of the most pressing health issues facing today’s global community. Unfortunately, the disease is a chronic, i.e. remain with the patient for life. However, diabetes can be successfully compensated. A key role is played by the timely diagnosis, appropriate treatment, self-monitoring and the implementation of the recommendations of the doctor.

The review considers a modern state and historic aspects of the compression use therapy for prevention of thromboembolic complications and therapy of symptoms of chronic venous insufficiency related to chronic vein diseases. Pathogenetic aspects of the therapy by graduated compression, fundamentals of use of mechanical means of prevention and therapy, fundamentals of these methods effect on the state of venous return, movement of tissue liquid are discussed. The attention is focused on evidence of effectiveness of compression therapy.

Patients with metabolic syndrome (MS) have an increased risk of developing cardiovascular diseases and type 2 diabetes mellitus, which makes it necessary not only to identify, but also to timely correct these conditions. Therapeutic measures in the treatment of patients with MS are directed to the main links of the pathogenesis of the syndrome and its complications: obesity, insulin resistance, violation of carbohydrate metabolism, dyslipidemia and arterial hypertension. Meanwhile, the niche remains for multi-potent drugs, simultaneously affecting several risk factors, united by a single pathogenetic basis. As a possible candidate, L-carnitine can be considered. The review describes cardioprotective, neuroprotective, nephroprotective and hepatoprotective effects of L-carnitine, its favorable effect on carbohydrate, fat and protein metabolism is noted, which allows treating the drug as a universal regulator of metabolic processes in the body in patients with MS and its various manifestations.

The extension of indications for endovascular treatment of complex coronary lesions, along with ensuring efficiency and safety, is the priority target of percutaneous coronary intervention (PCI) application for the coronary heart disease (CHD). Among the independent predictors of the adverse events of PCI, the diffuse coronary artery lesions is a separate object of interest. Substantial progress in treatment of this category of patients was achieved with the introduction of drug-eluting stents (DES). However, the method had a downside of late and very late stent thrombosis. In order to solve the problem stents with biodegradable polymer were developed. Efficacy and safety evaluation of new generation long DES in treatment of diffuse coronary artery lesions has become a promising research trend.

Aim. To estimate the dynamics of diastolic function (DF) of the left ventricle (LV) at patients with atrial fibrillation ()AF at various methods of sinus rhythm (SR) recovery. Material and methods. We examined 153 patients with the nonvalvular AF lasting from 48 hours to 6 months. All patients were divided in 3 groups. In group 1 (49 patients) SR was restored medically, in the group 2 (57 patients) SR was restored by means of electrical cardioversion (ECV), in the group 3(47 patients) underwent radio-frequency isolation of pulmonary veins (RFI PV). Echocardiography was performed to all patients at the time of AF, and also on 1,5,15 days and in 6 months after recovery of SR with an assessment systolic and the diastolic function of left ventricle (LV), thickness of walls of a myocardium, the front and back size of the left atrial (LA), volume of LA, and also time of restoration of the LA function on a transmitral flow – peak A. Results. Initially and during the period of observation the diastolic dysfunction (DD) of LV has been severe in group of RFI PV: at time of AF the peak of E was below, than in other groups (р < 0,05); Е’, the characterizing active component of a diastola, at time of AF and within 6 months after SR recovery also was the lowest in this group (р<0,05); E/E’ at time of AF and up to 6 months after restoration of SR – the highest has turned out at group of RFI PV (р < 0,05). And in this group the most expressed decrease of E/E’ was noted at patients without paroxysms of AF. In all groups E’ in the presence of AF was higher than after SR recovery. And also E/E’ was noted below at time of AF than after SR recovery at groups of medical restoration and RFI PV, and in group of ECV this parameter didn’t change. Conclusions: at patients with AF such parameters as E’ and E/E’ didn’t appeared true regarding DF LV, that demands search of the new markers DF LV at patients with AF.