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Aim. To study the frequency of prescriptions of various types of lipid-lowering therapy and their effectiveness in outpatient clinical practice based on the results of a questionnaire of primary care physicians.Material and methods. The study was performed in 2022 in 75 constituent entities of the Russian Federation with the participation of 1117 doctors working in outpatient clinics. Most of the doctors had work experience of 10-20 years or more. Doctors of polyclinics (therapists and cardiologists, etc.) before the start of the study received instructions, questionnaires for filling out, developed by the National Atherosclerosis Society. The frequency of prescriptions by primary care physicians of various types of lipid-lowering therapy and their effectiveness in terms of the frequency of achieving target levels of low-density lipoprotein cholesterol (LDL-C) was studied based on the results of a questionnaire.Results. Monotherapy with statins was prescribed in 55.2% of cases, free combination of rosuvastatin with ezetimibe – in 17.2%, single pill combination of rosuvastatin with ezetimibe – in 23.2%, combination therapy with PCSK9 inhibitors – in 4.1% of cases. Target levels of LDL-C ˂ 1.8 mmol/l and ˂ 1.4 mmol/l were achieved with statin monotherapy in 42.6% and 28.2% of cases, respectively, free combination of rosuvastatin with ezetimibe – in 61.7% and 39 .5%, a fixed combination of rosuvastatin with ezetimibe – in 67.8% and 48.5%, combination therapy with PCSK9 inhibitors – in 96.8% and 92.8% of cases.Conclusion. The single pill combination of rosuvastatin with ezetimibe is more effective in achieving target levels of LDL-C compared with statin monotherapy and therapy with free combination of statin with ezetimibe. Despite the fact that the target values of LDL-C when prescribing a combination with PCSK9 inhibitors were achieved in 96.8% and 92.8% of cases, they were used quite rarely at the outpatient stage of treatment in the Russian Federation.

This Expert Council focuses on the meta-analysis of studies on the risk of atrial fibrillation (AF) in patients taking omega-3 polyunsaturated fatty acids (PUFA) and of data on the omega-3 PUFA treatment in patients with cardiovascular and kidney diseases.The major statements of the Expert Council: the meta-analysis of AF risk in patients taking omega-3 PUFA showed an increased risk of this arrhythmia. However, it should be taken into account that the risk of complications was low, and there was no significant increase in the risk of AF when omega-3 PUFA was used at a dose of ≤1 g and a standard dose of the only omega-3 PUFA drug registered in the Russian Federation, considering all AF episodes in the ASCEND study.At the present time, according to Russian and international clinical guidelines, the use of omega-3 PUFA can be considered in the following cases: • for patients with chronic heart failure (CHF) with reduced left ventricular ejection fraction as a supplement to the basic therapy (2B class of recommendations according to the 2020 Russian Society of Cardiology guidelines (RSC) and the 2022 AHA / ACC / HFSA guidelines); • for patients with hypertriglyceridemia (>1.5 mmol/l) as a part of combination therapy (IIb class of recommendations and B level of evidence according to the 2021 European guidelines on cardiovascular disease prevention, etc.); • for adult patients with stage 3-4 chronic kidney disease (CKD), long-chain omega-3 PUFA 2 g/day is recommended for reducing the level of triglycerides (2C class of recommendations). Data on the use of omega-3 PUFA for other indications are heterogenous, which can be partially explained by using different form and doses of the drugs.

Inclisiran is a novel hypolipidemic drug that inhibits synthesis of the PCSK9 protein through the process called RNA interference. Inclisiran is a double-stranded, modified RNA bound to the N-acetylgalactosamine (GalNAc) carbohydrate molecule, a ligand of the acialoglycoprotein receptor, that is expressed by hepatocytes. After entering hepatocytes, inclisiran cleaves matrix RNA and, thereby, reduces the PCSK9 protein synthesis. This, in turn, enhances the uptake of circulating low-density lipoproteins (LDL) by specific receptors on hepatocytes, thereby lowering LDL levels in circulation. Efficacy and safety of inclisiran for lowering LDL cholesterol (C) in blood and its effect on the risk of clinical complications of atherosclerosis have been studied in the ORION program that includes multiple clinical trials. According to results of this program, inclisiran effectively reduces both LDL-C levels and the incidence of cardiovascular complications in the absence of clinically significant adverse reactions. An important advantage of inclisiran compared with other lipid-lowering drugs is the administration schedule (twice a year), which allows a considerable improvement of patients’ compliance with the treatment and also of the effectiveness of the hypolipidemic treatment.

The COVID-19 (COronaVIrus Disease 2019) pandemic caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome CoronaVirus 2) continues to be a global threat to people and health systems. As of March 21, 2022, there are more than 460 million cases and more than 6 million deaths worldwide, and more than 17 million and 360,000 respectively in the Russian Federation. Due to the rapid spread of the new coronavirus infection, since the beginning of the pandemic, tremendous efforts have been made to create new pharmacological agents to reduce morbidity and mortality, and tactics have been used to repurpose existing medications in treatment regimens for patients with COVID-19, particularly statins. Statins represent one of the most widely used and prescribed classes of drugs in the world. The hypolipidemic properties of statins are actively used to treat hyperlipidemia and primary and secondary prevention of cardiovascular diseases and their complications. Statins have a known safety profile, are inexpensive and accessible. In addition to their hypolipidemic effects, statins have a wide range of pleiotropic anti-inflammatory, antiviral, and antithrombotic effects potentially useful in the treatment of COVID-19. Presumably, the use of statins can reduce SARS-CoV-2-induced organ and tissue damage and improve lung function. The use of statins, particularly atorvastatin, as one of the most effective, widely prescribed and studied drugs in this class, as a safe, affordable and relatively inexpensive therapy may be a promising therapeutic approach in the fight against a new coronavirus infection.

According to the latest international and Russian guidelines for the treatment of dyslipidemias, statins are defined as the main group of drugs that significantly reduce the level of low-density lipoprotein cholesterol (LDL-C) effectively prevent atherosclerotic cardiovascular diseases (CVD) and complications and can slow down the progression of atherosclerosis. The principle “the lower LDL-C, the better” is especially relevant in categories of patients with very high and extreme cardiovascular risk, and therefore, in order to achieve target LDL-C values (≤1.4 is optimal ≤1.0) in this category of patients, high-intensity lipid-lowering therapy should be used. Rosuvastatin remains the most effective statin. Its use makes possible to achieve target lipid values at the starting dose of treatment, enhances adherence to treatment, and also reduces the frequency of side effects associated with the use of high doses of other statins. In addition, the proven ability of rosuvastatin to reduce the volume of atherosclerotic plaque, by reducing the level of pro-inflammatory cytokines and C-reactive protein, normalizing endothelial function, antiplatelet action, that is, rosuvastatin, in addition to its powerful lipid-lowering effect, has anti-inflammatory and anti-ischemic effects. Also, rosuvastatin can be successfully used in the presence of comorbidities, including chronic kidney disease and chronic heart failure. Taking into consideration the urgency of the fight against the COVID-19 pandemic (coronavirus Disease 2019), which covered 220 countries, due to the lack of effective etiotropic drugs, the possibility of using statins, including rosuvastatin, for the treatment of comorbid patients with COVID-19, was evaluated.

Mortality from cardiovascular diseases (CVD) in Russian Federation (RF) remains one of the highest in the world. Compared to 2003, the mortality from CVD decreased by 37%, but when compared with most European countries, it is 3 times higher. Most deaths (53%) occur due to coronary heart disease. While analyzing reasons of mortality, total economic impact due to hypercholesterolemia in RF is estimated as 1,3 trillion RUR annually. The prevalence of hypercholesterolemia is in more than 50% of working-age population in RF. Due to AISBERG study, the prevalence of HCE in ambulatory practice in RF is 84%. When using lipid-lowering medications, the frequency of reaching of target total cholesterol level does not exceed 12%. Active actions on primary and secondary prevention are needed to low mortality rate from CVD, including active promoting of healthy lifestyle, and prescribing if necessary of lipid-lowering therapy (LLT) regimens. The paper deals with significance of target low density lipoprotein cholesterol level in accordance with the latest recommendations as the main aim for LLT. Combined LLT with one of the most potent statins rosuvastatin and ezetimibe seems to be effective and safe strategy for achieving target lipid level in different populations of patients. At present, Rosulip Plus is available in Russia - an quantitative and proven combination of rosuvastatin and ezetimibe.

P urpose To demonstrate the value of chest computed tomography (CT) in patient with severe COVID-19 viral pneumonia in choosing the optimal treatment strategy Materials and methods Chest CT dynamic studies of a patient with severe bilateral polysegmental viral COVID-19 pneumonia were performed The analysis of CT scans images series is provided Results The presented clinical case demonstrates the influence of the lung CT results in choosing the optimal therapy, including the cytokine storm prevention using the interleukin-6 (IL6) receptor inhibitors The dynamic observation of the lungs in monitoring of the intensive therapy results was performed The changes of CT patterns depending on the disease stage and results of treatment was studied Conclusion The paper shows that CT diagnostics for coronavirus COVID-19 infection helps not only in making an accurate diagnosis, but also is necessary in dynamics for monitoring the course of the disease, including helping to determine treatment tactics to prevent the development of a cytokine storm Ц ель исследования Продемонстрировать возможности компьютерной томографии (КТ) легких в диагностике и динамическом наблюдении для выбора оптимальной тактики лечения тяжелого течения вирусной COVID-19 пневмонии Материалы и методы Предоставляется клинический опыт динамического наблюдения пациента с двусторонней полисегментарной вирусной COVID-19 пневмонией тяжелого течения, с помощью КТ легких Проведен анализ серии компьютерных томограмм органов грудной клетки в динамике Результаты В представленном клиническом примере продемонстрированы возможности мониторинга показателей КТ легких для решения вопроса о выборе терапии, в том числе о применении ингибиторов рецептора интерлейкина-6 (ИЛ6) для предотвращения развития «цитокинового шторма», а также дальнейшего наблюдения за результатами интенсивной терапии Изучена динамика КТ-паттернов в зависимости от стадии течения и результатов лечения вирусной пневмонии Заключение В работе показано, что КТ-диагностика при коронавирусной инфекции помогает не только в постановке точного диагноза, но и необходима в динамике для мониторирования течения болезни, в том числе помогает определиться с тактикой лечения для предотвращения развития «цитокинового шторма»

Background Chronic inflammation associated with the uncontrolled activation of innate and acquired immunity plays a fundamental role at all stages of atherogenesis. Monocytes are a heterogeneous population, and each subset contributes differently to the inflammatory process. High level of lipoprotein(a) [Lp(a)] is a proven atherosclerotic cardiovascular disease (ASCVD) risk factor. The aim of the study was to investigate the association between the increased concentration of Lp(a) and monocyte subsets in patients with different severity of coronary atherosclerosis. Methods 150 patients (124 males (82.6%)), median age 60 (54; 65) years undergoing coronary angiography were enrolled. Lipids, Lp(a) were assessed by enzyme immunoassay. Monocyte subpopulations (classical CD14++CD16-, intermediate CD14++CD16+, non-classical CD14+CD16++) were analyzed by direct immunofluorescence and flow cytometry. Results The patients were divided into two groups depending on the Lp(a) concentration: normal Lp(a) Conclusion Here we demonstrate the correlation between the Lp(a) concentration and the blood content of non-classical monocytes, regardless of gender and age. The hyperLp(a) and decreased quantity of classical CD14++CD16- monocytes were associated with the severity of coronary atherosclerosis. The expansion of CD16+ monocytes (intermediate and non-classical) in the presence of hyperLp(a) significantly increased the risk of stenotic three-vessel coronary artery disease. Further studies of the differentiation and functioning of subsets of monocytes in the presence of congenital disorders of lipid metabolism, and especially hyperLp(a), are needed. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): The study was approved by Russian Ministry of Health

Experimental and clinical data indicate a significant contribution of lipoprotein(a) (Lp[a]) to the atherogenesis. However, the pathophysiological mechanisms of this relationship are not fully understood.Aim. To investigate the distribution of Lp(a) in the population of the regions participating in the Study “Epidemiology of Cardiovascular Diseases in the Regions of the Russian Federation” (ESSE-RF) and to evaluate its associations with cardiovascular risk factors.Material and methods. Representative samples of the male and female population of 7 regions of the Russian Federation, aged from 25 to 64 years, enrolled in the multi-center cross-sectional epidemiological study were analyzed. A total of 10332 people were examined, of whom 3732 were men (36.0%) and 6600 were women (64.0%), the average age was equal in both sexes.Results. The mean value of Lp(a) reached 22.4 mg/dl (standard deviation 21.3 mg/dl) and significantly differed from the median (11.1 mg/dl; interquartile range from 3.9 to 20.2 mg/dl), forming the right-skewed distribution in both male and female population. Lp(a) levels were statistically significantly correlated with the level of low-density lipoproteins cholesterol (LDL-C), ароВ/аpoAI and total cholesterol. Notably, the odds ratios were growing by quintiles, and increased along with increasing lipid values (pConclusion. According to the ESSE-RF data, there are significant positive associations of Lp(a) with the LDL-C level, the ароВ/аpoAI ratio, total cholesterol, and hs-CRP. Negative associations are established with glucose and TG levels. The future studies should be planned with the notion of the Lp(a)’s right-skewed distribution type.

Aim. To assess the relationship between premature coronary artery disease (CAD) and various lipid parameters.Material and methods. This retrospective longitudinal study included 166 men aged 57±9 years with coronary CAD with onset before age of 55. The control group consisted of 62 men (60±8 years old) who did not have CAD and peripheral arterial disease. In all patients, data on following lipid profile parameters were collected: total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-high-density lipoprotein cholesterol (non-HDL-C) and lipoprotein(a) (Lp(a)) at the time of CAD onset, while in control group patients — at the first visit to the A.L. Myasnikov Institute of Clinical Cardiology. These indicators were measured in blood plasma at the time of enrollment in all patients. In addition, the concentration of LDL-C corrected for Lp(a)-cholesterol (LDL-Ccorr) was calculated. Hypercholesterolemia was diagnosed with an initial level of TC >5 mmol/l, or LDL-C ≥3,0 mmol/l, or non-HDL-C ≥3,8 mmol/l, while hyperlipoproteinemia(a) (HLP(a)) — at the level of Lp(a) ≥30 mg/dl.Results. Lipid metabolism disorders were significantly more common in patients with premature CAD compared to the control group. Lp(a) concentration ≥30 mg/dl, along with elevated levels of non-HDL-C or LDL-Ccorr, were associated with premature CAD, regardless of heredity and smoking, in the general cohort of examined men. Kaplan-Meier survival analysis showed that any type of lipid metabolism disorder was associated with an increased risk of premature CAD. In addition, patients with isolated elevated Lp(a) concentrations lived to the CAD onset 8 years earlier — 47 vs 55 years, pConclusion. HLP(a) is an independent factor of premature CAD, even with normolipidemia, which confirms the need for routine measurement of Lp(a) in clinical practice.

Aim. To evaluate the prevalence of familial hypercholesterolemia (FH) and hyperlipoproteinemia(a) (HLP(a)) in patients with premature acute coronary syndrome (ACS).Material and methods. The study included 120 patients with ACS up to 60 years (mean age, 53±7 years, 104 (87%) men) and 44 people from the comparison group without atherosclerotic cardiovascular diseases and dyslipidemia (mean age, 48±11 years, 19 (43%) men). All patients with ACS underwent coronary angiography. The lipid profile and lipoprotein(a) (Lp(a)) were determined in all patients.Results. The prevalence of HLP(a) in patients with premature manifestation of ACS was 41% (n=49), possible FH — 25% (n=30), combination of FH and HLP(a) — 13% (n=15). In the comparison group, an increased concentration of Lp(a) was detected in 14% (n=6). Based on the analysis of operating characteristic curves, Lp(a) ≥30 mg/dL had the maximum significance for ACS with a sensitivity of 40% and a specificity of 86% (area under the curve, 0,6; 95% confidence interval (CI), 0,5-0,7, p15 mg/dl was associated with two or more coronary artery lesions with a sensitivity of 67% and a specificity of 65% (area under the curve, 0,7; 95% CI, 0,6-0,7, pConclusion. Every fourth patient with premature ACS has FH, while almost every second has HLP(a), and every eighth has a combination of FH and HLP(a). HLP(a) is associated with ACS up to 60 years of age and multivessel coronary artery disease in these patients.

Aim. To analyze the relationship of blood lipid profile parameters, including the level of lipoprotein(a) (Lp(a)), and the content of circulating CD4+ T-lymphocytes with premature coronary artery disease (CAD).Material and methods. This retrospective cross-sectional study included 76 men aged 40 to 79 years. Patients were divided into following groups: main group — patients with CAD (58 [54;64] years, n=56) onset before the age of 55; control group — patients (62 [57;66] years, n=20) without CAD and obstructive CAD and peripheral arterial disease. Statins were taken by 51 (91%) and 9 (45%) patients in the main and control groups, respectively. In serum and plasma samples, lipid spectrum parameters and Lp(a) concentration were determined. Cellular phenotyping was performed by direct immunofluorescence in a culture of mononuclear leukocytes isolated from blood. To determine cytokines, cells were in vitro activated with inhibitor of intracellular transport of secretory proteins. Cell fluorescence was determined using flow cytometry.Results. Patients of both groups were comparable in age, body mass index, prevalence of hypertension and diabetes. Blood Lp(a) concentrations were higher in the CAD group than in the control group (49 [10;102] mg/dL vs 12 [4,3;32] mg/ dL, p14% of Th17) independently of each other, atherogenic lipoprotein cholesterol levels, classical risk factors, and statin use were associated with premature CAD in the general group of patients with odds ratio (OR) of 4,6 (95% confidence interval (CI), 1,1-20,2) and 10,9 (2,1-56,7), p30 mg/dl and Th17/1 over 14% significantly increased the risk of premature CAD (OR, 28,0, 95% CI, 4,31-181,75, p=0,0005).Conclusion. We have shown for the first time that an increased Lp(a) concentration with an increased Th17/1 content is associated with the premature CAD in men.

Raised level of lipoproteide (a) (Lpa) is an independent risk factor of coronary heart disease (CHD) and is also a monogenic predictor (there is growth of prevalence) of aortic stenosis (AS) with the increase of Lpa in population. Lysophosphatide acid, secreted by an enzyme with phospholipase D activity — autotaxin (ATX) is an inflammatory mediator. Humoral immunity involvement in inflammatory processes in coronary arteries and aortic valve might present with the presence of circulating autoantibodies and shifts in the values of cellular immunity.Aim.To assess the relation of Lpa, ATX and immunity with the presence of AS in chronic CHD patients.Material and methods.To a single moment study, 210 patients were included, with chronic CHD. Patients were selected to two groups by the presence (main group, n=47) or absence (controls, n=163) of degenerative AS by echocardiography. Patients were taking standard CHD therapy. All patients underwent clinical blood count, lipids concentration and Lpa. ATX, C-reactive protein, autoantibodies to ApoB-100 lipoproteides and their Cu2+-oxidated modifications. Phenotypes of apoprotein (a) were assessed in 168 patients.Results.CHD patients with degenerative AS were older (74,2±7,8 versus 67,6±9,4 y., p=0,0007), but did not differ by the clinical and biochemical characteristics, level of Lpa and high sensitive С-reactive protein (hsCRP). Concentration of АТХ in plasma was significantly higher (554±95 and 497±105 ng/mL, p=0,001), but the level of IgM autoantibodies against the oxidated lipoproteid (а) (oxLpa) — significantly lower (10,8 [7,9;15,1] and 13,4 [11,4;16,7] relative units, pConclusion.In the patients with chronic CHD, undergoing statin therapy, the levels of ATX, autoantiboides IgM against the oxLpa and relation of neutrophils to lymphocytes, but not the concentration of Lpa and low molecular phenotype of apo(a), were related to AS presence.

Development of innovational biotechnological medications based on humanized or completely human monoclonal antibodies or antisense oligonucleotides has opened a novel epoque in lipid disorders treatment. High efficacy of such biological drugs influencing the main chains of lipid metabolism (apoprotein B100, apoprotein (a), apoprotein CIII, proprotein-convertase subtilisin-kexin type 9, antipoetin like protein 3) does open a perspective for correction of severe and statin-resistant forms of dyslipidemias, with a possibility to achieve almost complete remission of the disease. However, the evidence of safety of antisense oligonucleotides drugs demands for broader investigation. Such drugs might be used in patients with orphan diseases or serious lipid disorders, not having alternative treatment. Vice versa, the drugs based on the human monoclonal antibodies thank to evidence are started to be in clinical use at the moment.

The question of the starting point of the ascent of I.V. Stalin to unified authority is still the key in the historiography of the October Revolution of 1917, which had a great influence on the formation of I.V. Stalin as a politician. The revolution has fostered in him a sense of purpose, a will to win, a desire not to overturn a political opponent. His role in the uprising is very modest. But from the speech to the speech on the pages of the Soviet mass media, Stalin more and more clearly emphasized his closeness to the leader of the revolution — V.I. Lenin, which was important for creating the image of one of the leaders of the armed uprising. Thus, the ascent to individual power began even before 1921, when Stalin became Secretary-General of the RCP (B).

Aim. To study the relationship between the concentration of lipoprotein (a) (Lp (a)) and autotaxin (ATX) in patients with and without degenerative aortic valve stenosis (AoS) in the presence of coronary artery disease (CAD).Material and methods. The study included 461 patients (mean age, 66±11 years, men, 323), 354 of whom had CAD with stenosis ≥50% in at least one coronary artery according to angiography. Degenerative AoS was diagnosed with ultrasound. The control group consisted of 107 patients without CAD and degenerative AoS. Concentrations of Lp (a), ATX, lipids and blood cells were measured for all patients.Results. CAD without degenerative AoS (group 1) was diagnosed in 307 patients, while 47 patients had CAD and degenerative AoS (group 2). Patients in both groups were older than patients in the control group (66±10, 74±8, and 61±13 years, respectively). The ATX level was lower in group 1 (median [25; 75%]: 495 [406; 583] ng/ml) than in the control group (545 [412; 654] ng/ml) or group 2 (545 [476; 605] ng/ml) (pConclusion. An elevated Lp (a) level is associated with CAD regardless of the aortic valve involvement, while an increased concentration of ATX and neutrophil to lymphocyte ratio in patients with CAD were associated with degenerative AoS regardless of age and other risk factors.

Familial hypercholesterolemia is the most common hereditary disease characterized by an increase in low density lipoprotein cholesterol levels and the premature development of atherosclerosis-related cardiovascular diseases. Diagnosis and treatment of such patients are associated with certain difficulties. This review presents data on the prevalence of familial hypercholesterolemia, identification of patients with such a diagnosis, prevention of adverse cardiovascular events, and also discusses the appointment of lipid-lowering therapy.

Lipoprotein(a) [Lp(a)] consists of an LDL-like particle in which the apolipoprotein B100 is covalently bound to apolipoprotein(a) by a single disulfide bond. Lp(a) is synthesized in the liver and its plasma concentration varies from 0 to 400 mg/dl. Increased level of Lp(a) is considered to be an independent risk factor of cardiovascular diseases and coronary heart disease. Data about the significance of hyperlipoproteinemia(a) in the development of atherosclerosis of peripheral (lower limbs) and carotid arteries remain controversial. This review is devoted to Lp(a), its relationship with atherosclerosis of different vascular beds, as well as modern possibilities of hyperlipoproteinemia(a) correction.

Series of experimental, epidemiological, and genetic studies have demonstrated that elevated lipoprotein(a) [Lp(a)] level is associated with cardiovascular disease independently from traditional risk factors of atherosclerosis. This review covers the basics of Lp(a) pathogenicity in atherothrombosis and scrutinizes the biology of proinflammatory activity of the particle. We describe the evidence base around Lp(a) as an independent cardiovascular risk factor by giving an update on the results of epidemiological studies and genetic findings. We have summarized present evidence of Lp(a) lowering strategies and their impact on clinical outcomes in patients with high Lp(a) levels. We highlight a rationale for increased investigational efforts to further assess whether targeting Lp(a) levels minimizes cardiovascular risk.

The article concerns prevalence and efficacy of primary and secondary preventive strategies for hyperlipidemia in Russian Federation. According to the European Guidelines 2013 for Treatment of Stable Ischemic Heart Disease and the American Guidelines for Hypercholestrolemia, the article emphasizes that the main drug class that is effective in prognosis improvement, are statins, without mentioning any specific name. Among the higher cardiovascular risk categories it is possible to use high doses or intensive regimen of the two most common statins: atorvastatin and rozuvastatin. The results of the largest meta-analysis VOYAGER with 32 thousands patients, are provided, showing more success against other statins to reach target low density cholesterol levels.

Statin intake is a standard in the treatment of patients with atherosclerosis nowadays. These drugs therapy associates with 30% risk reduction in mortality and coronary events. However , the threat of recurrent events is sufficiently high in large part of patients. This can be related to low level of high density lipoprotein cholesterol as well as elevated levels of triglycerides and lipoprotein(a). Nicotinic acid intake in these patients may be necessary for the normalization of lipid profile, including lipoprotein(a), and will be able to reduce residual cardiovascular risk. Evidence-based medicine data are presented to prove an efficacy of nicotinic acid in high doses in cardiology practice. Nicotinic acid both in monotherapy and in combination with statins contributes to coronary and carotid atherosclerosis regression and reduces an incidence of cardiovascular complications. Long-acting formulation of nicotinic acid, correct receiving regime and blood bio-chemical monitoring contribute to long-term safety of the drug in patients with clinically significant atherosclerosis.

The results of the recently completed clinical studies on the efficacy of atorvastatin in high doses are presented. In these studies high dose atorvastatin therapy was used in patients with acute coronary syndrome, chronic coronary heart disease, and percutaneous coronary interventions. Studies completed in Russia and devoted to efficacy of the high dose atorvastatin therapy are discussed specially.

Series of experimental, epidemiological, and genetic studies have demonstrated that elevated lipoprotein(a) [Lp(a)] level is associated with cardiovascular disease independently from traditional risk factors of atherosclerosis. This review covers the basics of Lp(a) pathogenicity in atherothrombosis and scrutinizes the biology of proinflammatory activity of the particle. We describe the evidence base around Lp(a) as an independent cardiovascular risk factor by giving an update on the results of epidemiological studies and genetic findings. We have summarized present evidence of Lp(a) lowering strategies and their impact on clinical outcomes in patients with high Lp(a) levels. We highlight a rationale for increased investigational efforts to further assess whether targeting Lp(a) levels minimizes cardiovascular risk.

Lipoprotein(a) - Lp(a) is an independent risk factor of atherosclerosis and its complications. In spite of the long period of Lp(a) research there is no complete understanding of its physiological role and atherogenic action. The goal of this study was to investigate the presence in human plasma of circulating autoantibodies to Lp(a) belonging to different classes of immunoglobulins, and to elucidate their relationship to the presence and severity of coronary atherosclerosis in middle aged patients with coronary heart disease.Autoantibodies to Lp(a) and LDL level were measured in 97 men with quantitative angiography data. Among these patients 17 had intact vessels and 80 had stenoses50% in 1 or more large coronary arteries.Lp(a) level in patients with coronary atherosclerosis (CA) was significantly higher (median 19.0 [95%CI 12.9-27.3] mg/dl) than in patients without CA (median 10.2 [95%CI 4.5-18.3] mg/dl, p=0.05). Level of IgG autoantibodies to Lp(a) was also elevated in patients with verified CA (264 ± 188 and 187 ± 59 RLU, respectively, p=0,003). Correlation analysis showed significant association between Lp(a) concentration and presence of CA (r=0.20, p=0.05). Level of antibodies against Lp(a) correlated with the quantity of affected coronary arteries (r=0.27, p=0.008).Plasma concentration of Lp(a) as well as elevated level of autoantibodies to Lp(a) were associated with the presence and severity of coronary atherosclerosis in examined patients.

Plaque complication depends on its composition and phenotype rather than on the degree of stenosis. Plaque rupture predominantly occurs in areas with large lipid core rich in cholesterol and thin fibrous cap. Features of unstable atheromas are mostly described in patients with acute coronary syndromes (ACS). The aim of our study was to assess the plaque characterization and arterial remodeling process in non-significant stenoses of patients with chronic coronary heart disease (CHD) using intravascular ultrasound (IVUS) radiofrequency (RF) data. Methods. The study included 22 stable patients (68% men, mean age 54+/-6 years) with CHD and clinical indications for coronary angiography (CAG). Diameter stenosis of the target coronary artery for IVUS procedure had to be less than 60%. Thin-cap fibroatheroma (TCFA) was defined as plaque burdengt;40% and amount of NCgt;10% without detectable overlying fibrous cap segment. Results. Sample size calculations based on the IVUS evaluation showed 54 atheromas in 29 target arteries. Features of vulnerability determined as TCFA were detected in 14 (26%) lesions. Compared with stable lesions VPs were associated with a greater plaque burden (48.5+/-8.0 mm2 vs 55.8+/-9.3 mm2, p=0.03), larger quantity of necrotic core (37.1+/-9.1% vs 24.0+/-12.6%, p=0.0045) and calcium content (22.7+/-8.5% vs 5.6+/-5.2%, plt;0.000l), and less fibrous component (34.8+/-7.0% vs 60.4+/-12.4%, plt;0.0001), respectively. Significant correlation was obtained between positive remodeling (defined as remodeling indexgt;1.05) and NC percent area (r=0.389. p=0.005). Conclusion. In chronic CHD patients about 25% of atherosclerotic lesions responsible for less than 60% stenosis could be classified as vulnerable plaques. These borderline lesions contain more necrotic and calcium components compared with stable plaques, and are associated with positive arterial remodeling.

To determine distribution of different atherosclerosis risk factors and their correlation with severity of coronary arteries (CA) affection in young men.A total of 235 males aged 28-45 years were examined with coronarography which detected more than 50% narrowing in one or several major CA in 200 patients (the study group with coronary artery disease), 35 males without coronary stenosis served control. Atherosclerosis risk factors, serum lipids, lipoprotein(a), fibrinogen, C-reactive protein (CRP) were assessed.Smoking and hyperlipidemia (HLE) were registered in the study group more frequently. The level of lipoprotein(a) above 30 mg/dl was recorded in 98 (49%) and 7 (20%) patients of the study and control group, respectively (p = 0.001). As shown by a correlation analysis, the number of affected CA was associated with smoking (r = 0.2; p0.001), HLE (r = 0.23; p0.001), concentration of total cholesterol (r = 0.23; p0.0.001), lipoprotein (a) (r = 0.26; p0.001) and CRP (r = 0.26; p0.05). The level of lipoprotein(a) in patients with myocardial infarction and occluded artery was significantly higher than in patients without myocardial infarction and non-occlusive CA affection.The presence and severity of coronary atherosclerosis in young men with coronary artery disease are associated with smoking, HLE and high concentration of lipoprotein (a).

Frequency of thyroid gland functional disturbances after introduction of iodine-containing radiographic contrast agents during coronary angiography was studied in 146 patients, residents of the zone of borderline iodine deficit. Frequency of thyroid pathology was high at baseline (39%). Functional state of the thyroid gland was assessed before and 1, 3, 6, 12 months after investigation. During first month after coronary angiography there were several new cases of thyrotoxicosis and hypothyroidism, as well as deterioration of preexisting functional disturbances of the thyroid. Patients with baseline pathology and functional disturbances of thyroid gland before conduction of coronary angiography should be included into risk group of development of iodine induced states.

To study a correlation between lipoprotein(a) [LP(a)], as well as the phenotype of apoprotein(a) [apo(a)] and the presence of intermittent claudication (IC).The study included 25 patients (9 females, 16 males; mean age, 63.4 +/- 8.2 years) and 50 individuals (21 females, 29 males; mean age, 61.3 +/- 6.1 years) of a control group.In the patients, the level of LP(a) was 3 times higher than in the controls (median 39 and 13 mg/dl, respectively; p0.01). The low molecular-weight phenotypes of apo(a) occurred significantly more frequently in the patients than those in the controls (62 and 28%, respectively; p = 0.02).Multifactorial analysis has shown that the level of Lp(a) is an independent and important factor associated with the presence of IC.

To evaluate in a case-control cross-sectional study whether lipoprotein(a) concentration and apo(a) phenotypes are associated with the presence and severity of coronary and carotid atherosclerosis.We have examined 198 male CHD patients (mean age 53 +/- 8) years) with stenosis more than 50% at least in one main coronary artery or its major branches. Duplex scanning was performed in 168 patients to assess the degree of carotid atherosclerosis. Seventy six apparently healthy men (mean age 39 +/- 9 years) formed the control group. Lp(a) concentration was measured by ELISA, apo(a) phenotyping was performed by immunoblotting.Lp(a) level was significantly higher in cases compared to controls: 37 +/- 31 mg/dl vs. 18 +/- 27 mg/dl, p0.05. Patients had low-molecular weight apo(a) phenotypes more frequently than controls: 46% vs. 29%, p = 0.01. Patients aged 45 years and younger had low-molecular weight apo(a) phenotypes more frequently than older ones (65% vs. 42%, p0.05) and controls (65% vs. 29%, respectively, p = 0.001). High Lp(a) level and low-molecular weight apo(a) phenotypes correlated with presence and number of coronary occlusions.There was association between Lp(a) level, low-molecular weight apo(a) phenotypes and presence, severity, extension of carotid atherosclerosis. No differences in distribution of other CHD risk factors among all subgroups of patients were found.

Plasma sialyltransferase activity measured by incorporation of cytidine 5;-phospho[14C]acetylneuraminic acid (CMP-NeuAc) into asialofetuin was twofold higher in patients with documented atherosclerosis than in healthy donors. Kinetic studies showed that the enzyme affinity for CMP-NeuAc is the same in donors and patients. Low activity of plasma sialyltransferase in donors may be due to low blood content of this enzyme.

The relation between lipoprotein Lp(a) levels, other lipids and severity of coronary atherosclerosis was studied in 281 patients (241 men and 40 women aged 24 to 68 years) with suspected or diagnosed coronary heart disease. All of them underwent coronary angiography. The angiograms were evaluated according to two scores: vessel score (0 to 3 points for 0 to 3 vessels with stenoses50%) and stenosis score (0 to 32 points, number and severity of coronary lesions). 224 patients with verified coronary atherosclerosis were grouped according to these scores and compared with subgroup of 57 patients with intact coronary arteries. Lp(a) levels were significantly higher in patients with 1-, 2- (p0.05) and 3-vessel (p0.01) disease and stenosis score more than 10 points (p0.01). LDL cholesterol (LDL-C) levels were significantly higher in patients with 2- and 3-vessel disease and stenosis score more than 10 points (p0.05 in all cases). There was a positive correlation between Lp(a) levels and severity of coronary atherosclerosis (p0.05). Lp(a) contributes15% of total plasma cholesterol (TC). After subtraction of Lp(a)-cholesterol from TC according to modified Friedewald formula there was no any correlation between Lp(a) and LDL-C levels.