Despite our achievements in modern medicine, arterial hypertension (AH) remains one of the main causes of fatal complications, such as myocardial infarction and acute cerebrovascular accident leading to disability and mortality of patients, including those of working age. The prevalence of hypertension is significantly higher among old and senile age population, however, it has recently tended to increase in young and middle-aged people. Thus, the Russian epidemiological ESSE-RF study, in which representative sample of the Russian population aged 25–64 years were studied, showed that the prevalence of hypertension in individuals of that age group was 44%. It was predicted that the world’s burden of hypertension would increase by 15–20% to approximately 1.5 million people in the year 2015. Due to the high incidence of hypertension and complications associated with hypertension development, further study of pathogenetic mechanisms, development of diagnostic examination methods, prophylactic measures and the search for new treatment options with fixed-dose combination drugs is an important area of modern medicine. This article provides an overview of clinical studies of the components (lisinopril and indapamide) of a rational ACE inhibitor–diuretic combination and a clinical example.

Today, cardiovascular diseases remain the leading cause of morbidity and mortality globally. Hyperlipidemia and dyslipidemia are key points in the occurrence and progression of CVDs, as well as the development of its complications. Elevated low density lipoprotein cholesterol (LDL-C) is the target of lipid-lowering therapy. The LDL-C target level is often not achieved in everyday clinical practice, which is especially important for patients at high and very high risk for cardiovascular complications. Furthermore, in some patient subgroups, atherogenic dyslipidemia is observed. Due to use of intensive and prolonged lipid-lowering therapy, the problem of its tolerability and patient adherence to the treatment becomes a live issue today. In addition, the use of drugs with effect that complements and enhances the effect of statin helps to achieve targets and improve long-term prognosis. Statins and ezetimibe are effective and widely used drugs to treat dyslipidemia. Clinical studies show that ezetimibe can be safely co-administered with statins to enhance lipid-lowering activity. In this regard, a statin and non-statin drug fixed-dose combination tablet may have additional advantages both for enhancing the lipidlowering effect and for greater patient convenience. Rosuvastatin is more effective than other statins in reducing low density lipoprotein cholesterol. The article provides a rationale for the possibility, efficacy, safety and convenience of using an ezetimibe and rosuvastatin fixed-dose combination tablet in patients with a high and very high risk and unattained target level of low density lipoprotein cholesterol.

Coronary artery disease (CAD) can manifest as a classic chest pain, or atypical angina. At the same time, the prevalence of CAD in a group of male patients with atypical angina over the age of 60 can reach 59--78%. It should be noted that the clinic manifestation of the chronic heart failure (CHF), which will be the main limiting factor, may take centre stage in diffuse coronary artery atherosclerosis. In patients with coronary artery disease and heart failure, who take atorvastatin, one should expect a decrease in the risk of adverse outcomes and hospitalizations due to heart failure. However, this does not negate the need for treatment and optimization of heart failure, if necessary. The therapy of these patients is based on the administration of high doses of angiotensin converting enzyme inhibitors (ACE inhibitors), beta-blockers (BB) and statins. The routine use of statins in heart failure with low ejection fraction (EF) is not recommended for the management of patients with heart failure from clinical guidelines point of view. This conclusion is based on two multicenter randomized clinical trials that have purposefully studied the use of statins in heart failure (CORONA and GISSI-HF). However, this document recommends the use of statins to prevent heart failure in patients with coronary artery disease. Continuing statin therapy in patients, who are already receiving these drugs for coronary artery disease or hyperlipidemia, should also be discussed. Thus, the use of atorvastatin in patients with coronary artery disease and systolic left ventricular myocardial dysfunction can reduce the risk of adverse outcomes and hospitalizations due to heart failure. In patients with non-ischemic heart failure, taking statins is not associated with improved survival. Thus, the decision to prescribe this group of drugs in patients with chronic heart failure should take into account the specific clinical situation and be strictly individualized.

An analytical article discusses the design and results of the recent COMPASS study. Particular attention is paid to the details of comparison of the efficacy and safety of rivaroxaban combined with acetylsalicylic acid and the efficacy and safety of drugs containing acetylsalicylic acid only in patients with stable coronary artery disease. In addition to a significant reduction in the risk of the sum of traditionally recognizable events (myocardial infarction, stroke, cardiovascular mortality), among the arguments in favour of fairly widespread prolonged use of the antiplatelet agent combined with anticoagulant is an attractive effect of the debated antithrombotic strategy on the overall mortality of patients, an acceptable ratio of efficacy and hemorrhagic safety, first of all the absence of the increased risk of fatal bleeding and the risk of intracranial bleeding. The article describes approaches to the selection of patients with coronary artery disease for the participation in the long-term treatment with rivaroxaban combined with acetylsalicylic acid. Alternative possibilities for enhancement of the secondary prophylactic effects of acetylsalicylic acid are mentioned, the arguments supporting the preference of the approach discussed in the article are presented.

Objective. Comparison of the cardioprotective efficacy of valsartan/sacubitril and candesartan in women with heart failure (HF) and an initially reduced left ventricular ejection fraction receiving breast cancer chemotherapy.

Material and methods. A prospective study included 112 women aged 53 to 65 years with systolic heart failure, who received surgical treatment for breast cancer followed by adjuvant polychemotherapy according to the FAC scheme (fluorouracil + doxorubicin + cyclophosphamide) - 6 cycles with intervals between 21 days of administration. After randomization, HF therapy with nebivolol, eplerenone, and valsartan/sacubitril (n = 55) or candesartan (n = 57) was performed. A general clinical laboratory study, electrocardiography, daily Holter monitoring of an electrocardiogram, echocardiography, a 6-minute walk test, quality of life assessment were performed initially and repeatedly after 1, 3, and 6 chemotherapy courses.

Results. Both groups showed a tendency to troponin I level increase and a significant decrease in the concentration of N-terminal prohormone of brain natriuretic peptide. Only the valsartan/sacubitril group showed a statistically significant increase in the 6-minute walk distance, suppression of ventricular cardiac arrhythmias, improved indicators of systolic function of the left ventricle and quality of life when the Minnesota questionnaire was used.

Conclusion. The first randomized trial of valsartan/sacubitril showed superiority compared to candesartan in the treatment of heart failure in women with breast cancer, who received adjuvant chemotherapy, which included anthracycline antibiotic, doxorubicin.

An urgent public health problem is the optimization of drug therapy in patients with chronic heart failure.

A large number of works devoted to the treatment of chronic heart failure form the point of view that about the treatment of chronic heart failure «all is well known for a long time.» However, in real clinical practice, especially at the stage of primary health care, for various reasons, possible pitfalls, reefs and shallows are not taken into account, the underestimation of which can introduce certain difficulties and cause the treatment of patients with chronic heart failure to be ineffective.

The review article examined a number of important aspects of the treatment of chronic heart failure, which, for various reasons, are underestimated in the supervision of patients. First of all, this refers to antagonists of mineralocorticoid receptors, in particular to spironolactone, and an inhibitor of If - channels of the sinus node ivabradine.

The results of foreign and Russian studies, modern recommendations for the supervision of patients with chronic heart failure, indicate that the presence of spironolactone and ivabradine in the arsenal of a practical doctor allows optimizing drug therapy in patients with chronic heart failure and increasing its effectiveness.

In the review based on existing clinical recommendations and guidelines of the European cardiology society and results of clinical and register trials difficult questions about a antithrombotic therapy in the patients with an acute coronary syndrome and percutaneous coronary interventions were discussed. The perspective strategy of risk management on ischemic and hemorrhagic events were described. Need of the maximum personification of purpose of double antithrombotic therapy at patients with an acute coronary syndrome or after carrying out transdermal coronary interventions is updated. Real requirement on constant assessment of balance in risks of ischemic and hemorrhagic events in this group of patients were defined. The perspective strategy of risk management in ischemic and hemorrhagic events from a position of results of relevant clinical trials were described. Results of clinical trials (TOPIC, TROPICAL-ACS) about transfer the ACS patients from “new” desaggregants on clopidogrel were presented (De-Escalation approach). Examples of the clinical situations suitable for realization of such approach were reviewed. The prospects of use of De-Escalation approach are designated and positions of a clopidogrel and, in particular, the original drug Plavix were provided. At the same time, appointment in patients with ACS within 12 months of double antiaggregant therapy is the proved option of treatment allowing to improve the prognisis. However, in some cases there is a reasonable requirement of the transfer of the patient from the “new” antiaggregants (ticagrelor or prasugrel) to clopidogrel (“de-escalation”). It needs to perfome according to the available evidence base recommendations and it is strict according to clinical indications. In particular, patients can have a perspective de-escalation with high risk of bleedings or with already developed bleeding; in patients with the forced refusal of reception of “new” antiaggregants owing to development of side effects / intolerance / allergic reactions; in the presence of indications for life long intake of anticoagulants in case of the need for purpose of double or triple antithrombotic therapy; in patients with ACS with low risk.

Given the significant increase in the frequency of atrial fibrillation (AF) in elderly and senile patients with confirmed coronary heart disease (CHD), the study of the relationship between the polymorphisms responsible for the functioning of the renin-angiotensinaldosterone system and the presence of this disease becomes relevant. Purpose of the study. To study the genetic polymorphism of the CYP11B2 gene in elderly patients with ischemic heart disease, as well as to identify the role of aldosterone synthetase in the development of AF in this category of patients. Materials and methods. The study included 140 patients of both sexes (54,3% – men), over the age of 60 years, with confirmed coronary artery disease and any form of AF (the last episode no later than 12 months from the date of inclusion in the study). 84 patients agreed to participate in the study of aldosterone synthase polymorphisms. The control group consisted of 34 patients who had no diagnosed non-infectious diseases at the time of the survey. Both groups were comparable in age and sex characteristics. Results. Comparative evaluation of the distribution of genotypes and alleles – C344/T of the aldosterone synthase gene among patients with AF+CHD and relatively healthy individuals revealed that in the first group, most patients had the CYP11B2 T/T genotype in 38,1% of cases, the incidence was higher, than in patients of the comparison group – 14,7% (OR = 3.44, CI 1.07-11.07, p = 0.038). The frequency of detection of genotypes of CYP11B2 С/T and CYP11B2 С/С did not significantly differ in the compared groups. In the group with AF+CHD, the T allele was significantly more common (53,6% vs. 35,3%; p<0,05), while the frequency of occurrence of allele C was significantly higher in the group of relatively healthy individuals (64,3% vs. 47,1%; p<0,05). Conclusion. AF in elderly and senile patients with CHD is associated with the presence of CYP11B2 T/T genotype (OR = 3,44, DI 1,07–11,07, p = 0,038) and is not associated with myocardial echocardiographic parameters, including the size of left atrium.

For many years, there has been no model capable of explaining the complex processes of interaction between various bloodclotting factors leading to a stop of bleeding. One of the most successful models able to partially reflect the mechanisms of hemostasis for a long time was the cascade theory. The cascade model perfectly explains the processes occurring during coagulation in vitro, but was completely inadequate in attempts to evaluate the processes occurring in vivo. A significant drawback of the cascade model is the impossibility to trace the interaction of cells carrying the tissue factor, platelets and plasma coagulation factors on their surface, since these conditions cannot be imitated. The cell theory, which has replaced the cascade theory, pays attention not only to the interaction of plasma coagulation factors, but also takes into account the role of platelets as important participants of coagulation processes. It is based on a four-stage reaction cascade that includes the following stages: initiation, amplification, propagation, and termination.

The cell theory of hemostasis is able to reflect the complex process of interaction of all the links of hemostasis and answer questions related to the problems in patients with disorders of the coagulation system. The cell theory of hemostasis allows to reflect more precisely the processes of hemostasis in vivo and to interpret correctly the results of tests and pathophysiological mechanisms of disorders of the coagulation system. Global tests (thrombin generation assay, thromboelastography, thrombodynamics) used for hemostasis system evaluation are more complimentary with cell theory of hemostasis.

Hyperphosphatemia in renal pathology is a key factor for developing mineral and bone disorders. It can develop even in the early stages of renal function decline and predict the formation of vascular calcification and an increased risk for developing cardiovascular complications in patients with chronic kidney disease, especially in those, who receive program hemodialysis. The use of calcium-free phosphate-binding agents that are not associated with the risk for developing hypercalcemia can slow the development of vascular calcification, reduce the incidence of adverse cardiovascular events and mortality in patients with chronic kidney disease.

Aim. To estimate the prevalence of inflammatory residual risk in patients with stable atherosclerotic cardiovascular disease (ASCVD) and establish the relationship between concentration of C-reactive protein (CRP) and the presence of the polyvascular disease.

Materials and Methods. The study included 120 patients with stable ASCVD. The plan of the instrumental study included ultrasound scanning of the carotid arteries and lower limb arteries with measurement of the ankle-brachial index. The concentration of hsCRP in the serum was determined by the enzyme-linked immunosorbent assay.

Results. An increase in the content of hsCRP ≥ 2,0 mg/l was detected in 45,8% of patients. Clinically significant lesion of one vascular bed was observed in 41,6% of patients, two – in 36,6%, three – in 21,6%. In the group of patients with atherosclerosis of the three vascular beds, the median value of hsCRP was 3,28 (1,77–5,67) mg/l, which was statistically significantly higher compared to patients with the involvement of one vascular bed – 1,56 (0,68–3,92) mg/L. An increase in hsCRP over 2,0 mg/l was associated with an increase in the relative risk of a patient with polyvascular disease with a atherosclerosis of three vascular beds 3,63 times (95% CI 1,06–12,4; p = 0,04) with adjusting for gender, age, obesity, diabetes, smoking, cholesterol levels and glomerular filtration rate.

Conclusion. Inflammatory residual risk was observed in 45,8% of patients with stable ASCVD. An increase in CRP was established with an increase in the number of affected vascular beds. An increase in hsCRP over 2,0 mg/l was independently associated with an increase in the relative risk of a patient having an polyvascular disease.

Current perspectives in the management of blood pressure and reduction of cardiovascular risks. Based on the proceedings of the XXVI Human and Medicine Congress and 3rd Cardiovascular Summit.