The article tells about optimum choice of combination antihypertensive therapy in patients with diabetes mellitus 2. The article discusses the efficacy of combination therapy based on two types of RAAS blockade (angiotensin-converting enzyme inhibitor or angiotensin II receptor antagonist) with indapamide retard and amlodipine, and the treatment regimen without RAAS blockers, which is based on the combination of dihydropyridine calcium channel blocker, indapamide retard and cardioselective beta blocker. The clinical experience with the three mentioned schemes of anti-hypertensive therapy is described; the benefits of combination of perindopril and amlodipine prior to valsartan and amlodipine or amlodipine and metoprolol succinate are demonstrated.

Numerous studies have shown that diabetes and hypertension are similarly associated with increased cardiovascular mortality. The presence of both diseases increases mortality risk two-fold. At the same time, 80% of cases of diabetes mellitus are associated with hypertension. [1, 2] The strong relationship between the diseases is based on the similarity of their pathogenetic links, such as insulin resistance and hypersympathicotonia.

The article is a short overview of articles related to the prescription of combination antihypertensive therapy. The focus is on the evidence of administration of a fixed combination - lercanidipine plus enalapril, which is characterized by a high antihypertensive efficacy, low rate of side effects, a proven organoprotective (primarily nephroprotective) action and absence of negative impact on lipid and glucose metabolism. This allows to prescribe this combination to patients in all age groups as well as patients at high cardiovascular risk.

The article reviews the efficacy of angiotensin II receptor blockers in the treatment of hypertension.

In Russia, cardiovascular diseases account for 57% of deaths in the overall mortality. Arterial hypertension (AH) is one of the main risk factors (RF) for cardiovascular diseases (along with dyslipidemia, smoking, metabolic syndrome, diabetes mellitus, alcohol abuse, etc.). AH is the largest contributor to cardiovascular morbidity and mortality, and a very common disease in Russia (about 40% of the adult Russian population suffer from hypertension).

Coronary artery disease is a leading cause of death in cardiovascular mortality. Studies conducted over the past decades helped to understand the specific pathophysiological processes occuring in cardiomyocytes during ischemia, to identify new clinical syndromes of ischemia and evaluate the cytoprotective role of therapy in combination treatment of coronary artery disease. Trimetazidine is one of the most studied drugs in cytoprotective treatment. High efficacy and good tolerability qualify it as the best way to protect cardiomyocytes in stable angina.

The review tells about the results of clinical trials and meta-analyses demonstrating the effectiveness of acetylsalicylic acid (ASA) for secondary prevention of cardiovascular diseases, namely, improved prognosis for patients after myocardial infarction (MI), stroke or transient ischemic attack (TIA), people currently having AMI, stroke and stable CAD. Risk reduction is most significant for non-fatal events, and less significant for cardiovascular mortality. However, indications for use of ASA in patients without established cardiovascular disease remain a subject for debate today, as interpretation of the available data on ASA effect in primary prevention is quite complicated, while long-term administration is associated with a risk of hemorrhagic complications. Guidelines of the Working Group on Thrombosis of the European Society of Cardiology and the American Diabetes Association are presented, where the use of ASA for primary prevention is justified only in patients with high cardiovascular risk. Safety issues in the ASA treatment and options for prevention of gastrointestinal bleeding are also discussed.

The article tells about the mechanisms of action of beta-blockers. Pharmacokinetic, pharmacodynamic and interaction properties of metoprolol are discussed. Findings on the efficacy and safety of metoprolol succinate and metoprolol tartrate in arterial hypertension, ischemic heart disease and chronic heart failure are presented.

The role of antithrombotic therapy in cardiology has increased substantially over the past decades. On the one hand, mortality causes monitoring, undertaken by certain countries as wellas on the global level under the auspices of the World Health Organization, demonstrate the leading role of thrombosis as a pathogenetic mechanism underlying the majority of premature deaths. The role of this mechanism is revealed by the excellent words of Jens Dedichen (1959): "Man lives with arteriosclerosis, and dies of the complicating thrombosis." [1] On the other hand, the widespread use of antithrombotic therapy is associated not only with the need to prevent both primary and, largely, recurring cardiovascular events, but also with a spread of minimally invasive revascularization techniques. Enovascular interventions the number of which has rapidly grown in in Russia over the past years, became a truly effective and safe treatment thanks to the present-day antithrombotic therapy.

Thrombotic and thromboembolic complications are associated with activation of blood coagulation and local thrombosis in different parts of the vascular bed. That determines the choice of drugs for the treatment of the existing thrombosis or its prevention. Treatment and secondary prevention of venous thrombosis and cardioembolic complications presupposes administration of anticoagulants such as warfarin, and a group of new drugs - direct blood coagulation inhibitors. Warfarin is effective in blocking thrombogenic activity and in cases of maximum thrombotic risks in patients with artificial heart valve, antiphospholipid syndrome, as well as in groups where no studies of new drugs were conducted. However, warfarin is associated with a number of limitations and requires strict compliance with rules and monitoring. Adverse effects of warfarin are to a certain extent addressed by the new group of anticoagulants - direct inhibitors of coagulation factor, which are registered in Russia for the prevention of venous thromboembolic complications after major orthopedic surgery, prevention of cardioembolic complications of atrial fibrillation, secondary prevention and treatment of venous thrombosis. The feasibility of switching to new drugs for stable patients receiving warfarin is doubtful. For patients just starting anticoagulant therapy, direct inhibitors of coagulation factor should be considered as the first-line treatment.

The lecture is based on 2014 ESC Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism (APE) 2014. It tells about the prevalence, risk factors and etiology of APE. The pathophysiological mechanisms of the development of respiratory and cardiac failure in APE are considered. The criteria for assessing clinical probability, sensitivity and specificity of laboratory and instrumental methods, algorithms for the diagnosis of APE and methods of risk stratification for early death of patients are discussed. While considering the current guidelines for APE pharmacotherapy, the authors focus on the use of new oral anticoagulants. In particular, they emphasize that in the acute phase of the disease, rivaroxaban and apixaban may be used as an alternative to the combination of heparin with warfarin. Indications, contraindications and regimens of thrombolytic therapy, and indications for surgical embolectomy and cava filter implantation are presented.

Cardiocerebral embolism is responsible for the development of 30-40% of ischemic stroke events. [1-3] Apart from its high incidence, cardioembolic stroke (CEI) is often associated with significant residual impairment of motor, speech and coordination functions, high risk of relapse, and significantly reduces the quality of life of patients. Therefore, it is relevant to timely diagnose the cardiac causes of stroke and determine the most appropriate prevention strategy.

Summary. The article examined the relationship between the risk of stroke and various profiles of lipid metabolism. The findings show that only statins, unlike many other lipid-lowering drugs, significantly reduce the risk of both primary and recurrent stroke. The discussion is focused on research findings demonstrating a lower risk of cerebral events during treatment with atorvastatin. It is stressed that in case of administration of generic drugs, the same level of efficiency and safety can only be guaranteed if the generic has a proven therapeutic equivalence to the original drug.

Lipid metabolism, and especially increased plasma levels of low-density lipoprotein cholesterol (LDLC), are positively correlated with the incidence and number of cardiovascular events - heart attacks and ischemic strokes. [1--7] Randomized trials of statins and a series of meta-analyses of statin trials - Cholesterol Treatment Trialists' (STT) Collaboration 2005, 2010, 2012 - demonstrated a close relationship between decrease in the "bad" cholesterol level on statin therapy and decrease in the number of cardiovascular (CV) complications. [8, 9] In the Russian Federation, despite advances in preventive cardiology in recent years, cardiovascular and total mortality rates remain high. Circulatory system diseases cause death of more than 1 million people in Russia annually; CS diseases account for more than 50% in the structure of total mortality. [5--7] Compared with other developed and developing countries, life expectancy in the Russian Federation, according to the WHO, remains low equalling an average of 66 years. Specifically in 2013, according to the WHO, average life expectancy of Russian people was low equalling an average of 66.05 in general, 59.1 years for men and 73 years for women. We are on the 129th place in the total list of countries, between Guyana and the Bahamas (Slide 1). One of the most challenging tasks in reducing CV mortality in this country is adequate monitoring of the key CV risk factors (diabetes, smoking, hypertension and dyslipidemia)

MERIDIAN-RO, a prospective cohort cross-sectional study with retrospective component, aimed to evaluate the incidence of lipid metabolism disorders in the Ryazan region and their relationship with chronic non-communicable diseases. In 2011, 1,622 people (1,220 urban and 402 rural) aged 25--64 years (mean age - 43,4 ± 11,4 years) 42.6% of which were males and 53.8% females, were included in the study. The cohort was observed for 36 months, the end points were evaluated annually. Biochemical samples, ECG and results of a survey using standardized questionnaire were assessed. A total cholesterol level above 2.5 mmol/L and/or low-density lipoprotein level above 2.5 mmol/L were considered as dyslipidemia. According to the study, the incidence of dyslipidemia in the Ryazan region was high and amounted to 84.1%. A less favourable lipid profile was registered in rural residents, requiring a more enhanced preventive intervention. Dyslipidemia in combination with CNCD increased the risk of adverse events. Of all lipid markers, only apoB was associated with the development of socially significant CNCD (CAD/MI/stroke, DM and CKD), thus making it necessary to include it in the standard examination of people with elevated total cholesterol and/or LDL.