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The results of studies investigating the clinical effects of cardiac rehabilitation (CR) in patients after acute myocardial infarction (MI) and cardiovascular surgery are discussed. It is known that CR programs vary in duration and dose (number of training sessions) across different countries. Systematic analysis of studies evaluating the clinical effectiveness of the program depending on its duration is relevant. The results of studies aimed at determining the minimum number of training sessions that can lead to a reliable increase in physical performance are also described. The analysis of studies on patients’ adherence to rehabilitation programs and its impact on the final clinical effects of CR is presented. It is shown that the most noticeable result is observed when patients participate in 80% or more of the required training sessions. Patients’ high adherence to physical training (PT) depends on many reasons. In this review we describe groups of patients with low adherence to PT. One of the important conditions for maintaining adherence to CR is a high-quality approach in management of such patients, giving a clearly noticeable favorable clinical effect. At the present stage, there is a need for individualization of CR strategy and transition to new forms of CR (home rehabilitation, tele-rehabilitation, etc.). When applying different "new models" of CR, it is important to maintain their high clinical efficacy.

The review discusses studies on clinical effects of exercise in patients after acute myocardial infarction and cardiovascular surgical interventions. Evidence of the high clinical effectiveness of training as an important component of cardiac rehabilitation programs is presented. The review presents the results of clinical studies on cardiac rehabilitation conducted in different countries.

Water aerobic training can be considered as an additional method of exercise in the rehabilitation of cardiovascular patients. The review examines the physiological effects of water training, the potential of its use in different categories of cardiac patients, its advantages, dosing the load and monitoring its intensity in the aquatic environment. The practical aspects of aqua aerobic training are discussed, and research data on its safety and effectiveness in cardiac rehabilitation programs is provided.

The Russian Society of Cardiology (RKO)With the participation of: The National Society for the Study of Atherosclerosis (NOA), the Russian Association of Endocrinologists (RAE), the Russian Society of Cardiosomatic Rehabilitation and Secondary Prevention (RosOKR), the Russian Scientific Medical Society of Therapists (RNMOT), the Eurasian Association of Cardiologists, the Eurasian Association of Therapists (EAT), the Russian Association of Gerontologists and Geriatricians

Aim. To study the clinical efficacy and safety of a personalized exercise program in the rehabilitation of patients with paroxysmal atrial fibrillation (AF) after primary pulmonary vein radiofrequency ablation (RFA).Material and methods. Patients (n=48) with paroxysmal AF who underwent RFA were randomized into two groups: main (n=24) — patients involved in the exercise program and received standard therapy; control (n=24) — patients received standard therapy. The program included exercise complexes with the calculation of energy consumption, step training and walking. The program lasted 6 months, while the follow-up period — 12 months. All patients in the study underwent a faceto-face learning interview.Results. After 6-month exercise program, bicycle ergometer test revealed an increase in duration (by 18,6%, p

Cardiac rehabilitation (CR) is one of the effective healthcare types for cardiovascular patients. At the same time, the choice of the most effective CR methods for a particular patient remains a problem. An increasing number of studies are devoted to the application of genetic methods for studying human health. Particular attention is drawn to determining the telomere length. The review purpose was to analyze the literature on various studies on the significance of assessing the chromosome telomeres for characterizing human health and choosing effective CR methods. The article discusses issues related to the relationship between the telomere length and cardiovascular risk factors, dietary pattern, and psychological status of a person. We also assessed the effectiveness of various exercise types at the genetic level. In preparing the review, publications over the past 14 years were searched in the MEDLINE/PubMed, Scopus, Cochrane Library, PEDro, eLIBRARY, and Google Scholar databases. The presented facts indicate the need for further study and effective use of one of the genetic factors protecting chromosome telomeres in CR.

The purpose of this review was to present modern studies that examine the relationship of physical activity and risk of atrial fibrillation (AF) development and the impact of cardiac rehabilitation programs in patients with all forms of AF. Data of 52 Russian and foreign scientific sources published in 1998- 2020 were presented. In our study, 48 patients with paroxysmal AF after radiofrequency ablation (RFA) were randomly assigned to a physical rehabilitation/standard therapy or control (standard therapy) group. Aerobic physical training was conducted for 6 months 3 times a week. AF is one of the most common cardiac arrhythmias. Despite modern advances, results of treatment of this disease are far from optimal. Many problems of patients with AF can be addressed through enrolment in multidisciplinary cardiac rehabilitation programs. But this question remains open. This is mainly due to the complexity of selection of physical rehabilitation program for patients with AF. It is known that physical activity can trigger an episode of AF. In the following review article, the approaches to functional capacity assessment of patient with AF are described, recommendations for prescribing safe exercise training to achieve a therapeutic effect are presented. Various aspects of the effects of physical rehabilitation are discussed, including its impact on cardiovascular risk factors, influence on atrial remodeling processes and associated biomarkers, prevention of AF progression and occurrence of cardiovascular complications. Results of our own research indicate effectiveness of physical training in patients with AF after RFA: increase in exercise duration by 18.6% (p

Disclaimer РThe EAC/RNAS Guidelines represent the views of the EAC and RNAS, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC and RNAS is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC/RNAS Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC/RNAS Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC/RNAS Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC/RNAS Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.Members of the Working Group confirmed the lack of financial support / conflict of interest. In the event of a conflict of interest being reported, the member (s) of the Working Group was (were) excluded from the discussion of sections related to the area of conflict of interest.

The article discusses different points of view on atherosclerosis development. The facts confirming the lipid hypothesis are presented. Attention is drawn to the possible participation of vasa vasorum in the development of atherosclerosis.

The review discusses the preparation of patients for surgery on the heart and other organs. We considered the importance of introducing a new stage of medical and cardiology rehabilitation — prehabilitation. The results of randomized clinical trials, systematic reviews and metaanalyzes evaluating the effectiveness of respiratory techniques and physical training during the prehabilitation are presented. Particular attention is paid to the involvement of patients in prehabilitation programs before the elective coronary artery bypass grafting. Methodological problems arising in the development of prehabilitation programs are discussed.

The expert consensus of the Russian communities discusses the issues of comprehensive medical rehabilitation of patients with coronavirus disease 2019 (COVID-19). COVID-19 is a contagious infectious disease that can cause pulmonary, cardiac, motor, metabolic, neurocognitive and mental disorders, that is, multiple organ dysfunction. COVID-19 survivors, especially after a severe clinical course, face serious psychological and physical problems, posttraumatic stress, cognitive dysfunction, nutritional deficiencies and exacerbation of concomitant chronic diseases. Some patients, regardless of the COVID-19 severity, have a long clinical course of the disease (“chronic-COVID”, “long COVID”). There is evidence of post-acute COVID-19 syndrome. In this regard, patients after COVID-19 will need rehabilitation measures. The expert consensus of the Russian communities presents general principles, stages and aspects of medical rehabilitation after COVID-19, indications and contraindications for rehabilitation interventions. The paper includes recommendations on comprehensive cardiac and pulmonary rehabilitation, as well as specifics of rehabilitation care for different COVID-19 courses within the national three-stage rehabilitation system.

Aim. To identify regional specifics of changes in mortality rates from acute types of coronary artery disease (CAD) in 82 Russian regions for the period from 2015 to 2019.Material and methods. The study used data from the Federal State Statistics Service of Russia on mortality from acute CAD types in 82 Russian regions. Standardized death rates (SDRs) for 2015 and 2019 were estimated based on the European standard. We analyzed the SDRs of the population from acute (primary) and recurrent myocardial infarction (MI), other acute CAD types (I21-I22, I24.8 in the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10)).Results. Over the period from 2015 to 2019, mortality from all acute CAD types decreased by 21%, from acute MI — by 9%, from recurrent MI — by 22%, from any MI (acute/recurrent) recurrent — by 14%, and from other CAD types — by 21%. A decrease in mortality from all acute CAD types was recorded in 69 regions, from acute MI — in 58 regions, and recurrent MI — in 62 regions. However, a simultaneous decrease in SDRs from each of the acute CAD types (acute MI, recurrent MI and other acute CAD types) for the period 2015-2019 occurred only in 29 Russian regions. An increase in mortality from all acute CAD types was noted in 14 regions and from any MI — in 21 regions. The coefficient of variation (Cv) for recurrent MI and other acute CAD types of 69% and 103%, respectively, in 2015 and its growth (up to 75% and 134%, respectively) by 2019 indicate growing problems with the coding of death causes.Conclusion. In 2019, compared to 2015, a decrease in mortality from acute CAD types was recorded in most Russian regions. The identified regional specifics require clarification of approaches to death cause coding and the introduction of additions to mortality reduction programs, taking into account the specifics of each Russian region.

Aim. To study the effectiveness of cardiorehabilitation (CR), based on one-year physical training (PT) of moderate intensity, with different levels of rehabilitation potential (RP) in patients of working age after myocardial infarction.Material and methods. The study included 300 patients having myocardial infarction 3-8 weeks ago. All patients were randomized into groups: the main “M” (n=155) for physical rehabilitation and the control “C” (n=145). Each group were divided into three subgroups depending on the level of RP, classified by exercise tolerance (ET) during the load test: high level — ET >100 W, medium >50- ≤100 W and high ≤50 W. Patients underwent PT of moderate intensity 3 times a week during a year. All patients received standard therapy.Results. Under the influence of PT, the power and duration of load increased, respectively, with low RP by 87,5% and 62,2% (p

It is known that in recent decades, methods of cardiac rehabilitation have been widely used in patients after acute myocardial infarction, coronary syndrome and cardiac operations. The main active factor in cardiac rehabilitation is a program of physical training. On the other hand, it has been established that physical training and/or sufficient physical activity positively affects the length of human telomeres. It is assumed that under the influence of cardiac rehabilitation, the improvement in the course of the disease may be due to an increase in telomere length. We found studies with such positive associations. This primarily concerns people with prediabetes, overweight, multiple risk factors. We established the importance of training in physically active people, athletes, especially with great sports experience. It seems promising to perform studies (training/telomeres) in patients with history of acute myocardial infarction, acute coronary syndrome and cardiac surgery.

Aim. To study the effectiveness of 1-year exercise training (ET) after acute myocardial infarction (AMI) during outpatient cardiac rehabilitation in patients with different body mass index (BMI).Material and methods. The study included 312 patients after AMI, who were randomized into four groups depending on BMI: patients who used ET program with BMI 30 kg/m2 (group 2 (n=78)); patients who did not use ET program with BMI 30 kg/m2 (group 4 (n=78)). ET of moderate intensity (60% of the threshold value) was carried out 3 times a week for a year.Results. In patients with obesity, ET was associated with decrease of blood pressure by 3,3/3,6% (p

Aim. Evaluation of the efficacy of 1-year exercise based program (EP) in coronary heart disease (CHD) patients of economically active age after acute myocardial infarction (MI), depending on smoking status.Material and methods. To the study, males included (n=338) after MI (not later than 3 weeks from the event). Four groups shaped by randomization: EP patients smokers (group 1, n=84), EP non-smokers (group 2, n=85); no EP smokers (group 3, n=85) and no EP non-smokers (group 4, n=84). All patients received standard medication treatment. The EP were added, of moderate intensity (50-60% from the load in exercise test) 3 times a week during 1 year.Results. After EP in smokers (n=41) and non-smokers (n=85) there was an increase of load duration by 30,3% (p

The review is focused on the role of ivabradine in percutaneous coronary intervention (PCI) and coronary bypass grafting (CBG) in coronary heart disease patients (CHD) with stable angina. The data provided, on insufficient clinical effect of PCI revascularization with modern medication therapy. Authors argue for improvement of the clinical effect of PCI and CBG by addition of ivabradine together with sufficient (up to maximal) dosages of beta-adrenoblockers (BAB). Inhibition of If-channels of cardiomyocytes with ivabradine makes positive influence on the main clinical endpoints. The role of multiple effect of ivabradine is highlighted, that increase efficacy of the drug.

Aim. To analyze, how is, under the framework of the Pilot Project, organized and being conducted the improvement of work of the known departments in exact medical institutions (MI) of RF for rehabilitation of cardiovascular diseases (CVD) patients at the three steps under the current “Order of medical care and medical rehabilitation”, and how do the scientifically proven and types and methods of cardiorehabilitation (CR) being implemented, and to try to elaborate on an exact algorithm for patients course.Material and methods. Into the Pilot Project, 17 MI included, from 13 entities of RF. For the analysis of effectiveness of organizational models of CR in MI the unified charts were developed making to assess the equality to the Order of the rehabilitation care provided to patients with CVD, of multidisciplinary team involved in care, the staff list and MI equipment. Specific charts included the units assessing the efficacy of work on three stages of CR: I stage — in resuscitation and intensive care unit or specialized cardiology department, II — in in-patient department, III — in polyclinics. The article presents data from CR analysis of Jan 2013 to Dec 2015. Results. The CR was organized at the stage I in 10 MI, stage II in 10 MI and stage III in 7 MI. By the year 2015, almost in all MI the multidisciplinary teams were shaped, including cardiologist, cardiorehabilitologist, exercise specialist, clinical psychologist, physiotherapist; the rooms for exercise were equipped, as the halls for education of patients. The start of rehabilitation process from ICU made it to decrease the remaining of patient on the bedside for 0,7 days in average (2013-2015) and for 1 day in cardiovascular department. About 67% myocardial infarction patients in average were transferred to the stage II of CR. In all MI there were educational Schools organized, and the explanatory talks with the relatives were done as well. By now, the project is on its way. Conclusion. The analysis of three-staged CR system for myocardial infarction patients according to current laws, showed significant improvement of rehabilitational activeness of the newly created multidisciplinary teams at all stages of CR, increase of the number of methods of CR and better fulfillment of those, as demonstrated the safety of proposed principals of physical rehabilitation according to the Russian clinical guidelines “Myocardial infarction with ST elevation: rehabilitation and secondary prevention” under the framework of the organizational model of CR.

Aim. To study the influence of amlodipine compounds: original and generic — on the levels of blood pressure (BP), under conditions of isometric load as well; on metabolic parameters and some factors of atherothrombogenesis, in patients with arterial hypertension (AH) and obesity.Material and methods. Totally, 30 patients included, with AH 1-2 grade, and obesity. After 2 weeks washout they were randomized to the group of original amlodipine and generic amlodipine (GA). Beginning dose was 5 mg and in 2 weeks increased to 10 mg daily if target BP was not reached (

The Pilot project «Development of medical rehabilitation system in Russian Federation» is the large Russian project which is intended to transform system of rehabilitation care for patients with stroke, heart attack, and after total hip arthroplasty. The present article is the second one in the series of publications of the Project’s protocol. The publication shows the criteria of translation from 1 to 2 stages of rehabilitation and from 2 to 3 stages for all three profiles of the project. Working peculiarities of the second phase of the project are prescribed which realizes the new model of rehabilitation with assessment according to the ICF, determination of rehabilitation diagnosis, work in multidistsiplinary team and the introduction of a new speciality – ergotherapy.

Aim. To study efficacy of moderate-intensity physical training (PT) and evaluate lipid-lowering therapy in patients with ischemic heart disease (IHD) after acute coronary events in real practice.Material and methods. A total of 392 patients survived during last 3-8 weeks myocardial infarction, unstable angina or myocardial revascularization were included into the study. Inclusion of patients with stable angina pectoris after hospital treatment was also possible. Patients were randomized to the main (n=197) and control (n=195) groups. Patients of the main group received moderate-intensity PT. All patients received beta-blocker, nitrate, ACE inhibitors and acetylsalicylic acid. Frequency of lipid-lowering therapy prescription and its efficacy were assessed in both groups. Duration of the study was 1 year. The efficacy of interventions was evaluated by the dynamics of plasma lipid levels, results of bicycle ergometry and clinical end points.Results. We observed increase in exercise test duration by 32% (p

Carnitine is a substance close to vitamins B, which participates in the mitochondrial energy synthesis. L-carnitine controls the rate of the long-chain fatty acid oxidation and acts as a specific co-factor facilitating their transport via the internal mitochondrial membrane. It also participates in the elimination of long-chain fatty acid excess from mitochondria and cytoplasm. These effects prevent cytotoxicity. This review presents the results of the studies which comply with the standards of evidence-based medicine. It has been shown that in patients with acute myocardial infarction (AMI), L-carnitine therapy was associated with a reduction in myocardial necrosis and an improved clinical course of AMI (end-point incidence in the main and control groups was 15,6% and 26%, respectively). In the first 5 days of L-carnitine therapy, there was a significant reduction in mortality in the main group of AMI patients. In patients with stable angina, L-carnitine reduces the risk of all-cause mortality, repeat AMI, and ventricular arrhythmias. In patients with intermittent claudication, L-carnitine significantly increases the pain-free walking distance. This medication is well tolerated, with no registered major adverse effects.

The paper analyses the modern state of the cardiac rehabilitation system inRussia. The state system of the stage-based rehabilitation of patients with acute myocardial infarction (AMI) or patients who underwent coronary artery bypass graft (CABG) surgery was implemented in the 1980s, but collapsed due to the dramatic social changes of the past two decades. In 2013, based on the law “Healthcare of the Russian Federation citizens’ which was approved by the Federation Council in 2011, the Ministry of Health launched the programme of the complex, stage-based rehabilitation of neurologic, cardiac, oncologic, and traumatlogical (central nervous system traumas) patients. The paper focuses on the cardiac rehabilitation of patients with acute coronary syndrome (ACS) and AMI, as well as individuals after CABG and intracoronary invasive interventions. The first stage is a cardiac hospital (including an intensive care unit), the second stage is an in-patient clinic of the rehabilitation centre, and the third stage is an out-patient clinic of the rehabilitation centre. The authors stress the importance of the problem which is still unresolved inRussia: the need for physical training programme as the crucial, obligatory component of cardiac rehabilitation. The data on medical and social value of cardiac rehabilitation are presented, which include significant reductions in lethality, hospital admissions, and disability, as well as a marked improvement in clinical course of the disease and quality of life. It is suggested that effective implementation of cardiac rehabilitation in the clinical settings is a method of reducing the excessive burden of mortality inRussia.

Aim. To study the effects of various atorvastatin doses on blood lipids, hemostatic parameters, endothelial function, renin-angiotensinaldosterone (RAAS) system, and circadian profile of blood pressure (BP) in patients with ischemic stroke (IS).Material and methods. The study included 34 IS patients (mean age 58,0±6,6 years) with serum levels of low-density lipoprotein cholesterol (LDL-CH) >2,5 mmol/l, arterial hypertension (AH), and BP levels

Aim. As a clinical part of the Russian multi-centre randomised study, to assess the clinical benefits and safety of adding Trimetazidine MB to the standard treatment scheme in patients with stable angina (SA), in order to optimise their ambulatory therapy and improve their compliance. Material and methods. The study included 981 patients with Functional Class (FC) II-III SA and various concomitant diseases and syndromes, such as chronic heart failure (CHF), Type 2 diabetes mellitus (DM-2), or chronic obstructive pulmonary disease (COPD) in smokers. All participants were divided into two groups: Group I (n=838) received standard therapy plus trimetazidine MB (70 mg/d, twice a day), while Group II (n=143) received standard therapy only. The treatment and follow-up phases lasted for 12 months. Results. In Group I, the weekly number of angina attacks decreased by 42 % from the baseline at one month (р

Aim. In a clinical and epidemiological study PERSPECTIVE, to investigate the secondary prevention implementation among stable angina patients in real-world clinical practice, and to evaluate compliance to Russian and international clinical guidelines on stable angina management. Material and methods. The study involved general practitioners and cardiologists (n=277). In the first part of the PERSPECTIVE Study, the data from out-patient medical histories (2768 patients with verified diagnosis of stable angina, SA) were analysed. Results. In SA patients, the prevalence of coronary risk factors (RFs) was high. The mean levels of blood pressure, blood lipids and lipoproteins, body mass index, and heart rate were substantially higher than the recommended target levels. At the same time, some positive changes in the clinical course of SA were observed, such as reduced incidence of angina attacks, decreased number of administered nitroglycerine tablets, and increased prevalence of Functional Class I-II SA. The qualitative changes in prescribed medications, including antianginal, anti-aggregant, and lipid-lowering agents, were also observed. Conclusion. The results obtained point to the need for further improvement of SA management in real-world clinical practice and for optimization of pharmaceutical therapy, in accordance with modern Russian and international clinical guidelines.

Application and efficiency of hypolipidemic therapy in comparison with the effect of physical training on the dynamics of blood lipids in patients suffering from coronary heart disease after acute coronary events was studied. We examined 392 patients from 11 scientific medical centers and 9 establishments of public health care in Russia. The patients were randomized into the intervention group (197 persons) and the reference group (195 persons). Confirmations of the positive effect of physical training on the level of cholesterol of HDL and atherogeneity coefficients were obtained. In the basic group, a decrease in the level of total cholesterol and increase in cholesterol of HDL turned out to be statistically significant. Differences in the dynamics of total cholesterol, cholesterol of HDL and the ratio of the former to the latter for the comparison between the groups were reliable in favor of the basic group. High efficiency of physical training in the elevation of HDL and decrease in atherogeneity index was stated.

The role of statins in the treatment and secondary prevention of cardiovascular events and adverse outcomes among high-risk coronary heart disease patients is discussed, using well-known clinical trials on simvastatin as an example. Lipid-lowering and pleiotropic statin effects are analysed in detail, by age, gender, and clinical group.

The review is devoted to diagnostics and differential treatment issues in elderly patients with stable angina. Therapeutic potential of modern antianginal and other cardiovascular agents is presented. Clinical aspects of pharmaceutical therapy in coronary heart disease patients are emphasized. Surgery potential in elderly patients is also discussed.

The article is focused on practitioners' attitude towards clinical implementation of coronary heart disease secondary prevention programs. Using large-scale clinical trials' results, it is demonstrated that in most countries, secondary prevention measures are gradually improving. Russian secondary prevention programs are characterized by a substantial divide between clinical practice and international standards. In particular, Russian physicians use low doses of strategically important agents, and rarely recommend lipid-lowering therapy to their patients (17%).

Aim. To study hypolipidemic effectiveness and safety of generic lovastatin (Cardiostatin®). Material and methods. This open, cooperative study included 90 patients with coronary heart disease (CHD) and hypercholesterolemia (

The authors discuss statinotherapy perspectives for secondary prevention, emphasizing statins’ effectiveness due to their high hypolipidemic activity and multiple pleiotropic effects. Aim. To study hypolipidemic activity and safety of generic atorvastatin (Liptonorm®), in comparison to original atorvastatin, Liprimar®. Material and methods. Thirty patients with coronary heart disease (CHD) and hypercholesterolemia (HCH) were randomized to 12-week original or generic atorvastatin treatment. Blood lipids, hepatic enzymes, and kreatine phosphokinase levels were measured. Results. Total cholesterol (TCH) levels in Liptonorm® and Liprimar® groups reduced from 7,7±1,25 to 4,4±0,8 mmol/l and from 6,9±1,3 to 4,6±0,7 mmol/l, respectively; low-density lipoprotein CH levels reduced from 5,4±1,4 to 2,7±0,7 mmol/l and from 4,7±1,3 to 2,7±0,7 mmol/l, respectively; triglycerides’ levels reduced from 1,7±0,7 to 1,2±0,3 mmol/l and from 1,9±1,0 to 1,2±0,4 mmol/l, respectively. High-density lipoprotein CH levels increased from 1,03±0,25 to 1,13±0,21 mmol/l and from 1,32±0,31 to 1,37±0,28 mmol/l, respectively. Lipid profile dynamics throughout the study was significant and similar in both groups; enzyme levels remained virtually Conclusion. Atorvastatin generic Liptonorm® demonstrated blood lipid effects similar to those for original atorvastatin.

The survey focused on municipal out-patient clinic internists' involvement into modified coronary heart disease risk factor (CHD RF) control, as well as on RF control effectiveness reported by the patients. Up to 73 % of the doctors confirmed clinical effectiveness of the intervention, and 53 % regarded it equally important as antianginal therapy. Nevertheless, there were numerous barriers for successful realization of CHD RF control measures. Delivering RF control advice was linked to doctors' working pressure in 50, 5 % of cases, to patients' cultural level in 78,8 %, to patients' interest and initiative in 33,3 %, and to personal patient-doctor relations in 21,2 %. Only brief advice was given by 44,9 % of the doctors, and no more than 18 % of the respondents were ready to forward their patient to the relevant specialist. Therefore, 26 % of the doctors reported providing lifestyle modification advice «never», «rarely», or «occasionally». Unsatisfactory follow-up on fulfillment of such advice was confirmed by 49 % of the doctors. According to patient-provided data, the majority of the patients were unable to recollect receiving any relevant advice from their doctors. Most doctors reported advising on lipid-lowering diet, body weight control and smoking cessation (94 % in each case), or physical training (77,5 %), but only 46,1 %, 32,3 %, 75,3 % and 23,8 % of their patients, respectively, confirmed receiving such recommendations. Moreover, even for smoking cessation advice, where doctor-patient reporting gap was minimal, only 13, 4 % of the patients confirmed being offered some cessation plan. Expectedly, the majority of quitters (68,85 %) were sure that cessation was their own accomplishment.

The article focuses on differential treatment of stable angina patients. Effects of main antianginal and anti-ischemic medication groups are discussed. Clinical aspects of nitrate therapy in coronary heart disease (CHD) management are emphasized. Nitrates’ potential in treating various CHD forms is discussed.

This review is devoted to pharmacological characteristics, action mechanisms, hypolipidemic activity, and pleiotropic effects of a new hypolipidemic medication – ezetimibe, inhibiting intestinal cholesterol absorption. The combination of ezetimibe with other hypolipidemic drugs (statins, fibrates, bile acid sequestrants) is described in detail. Initial doses of various statins, together with one tablet (10 mg) of ezetimibe, reduce low-density cholesterol level as effectively as maximal statin doses.

Aim. To investigate the influence of dynamical and low-extremity static physical exercise of varying intensity on serum lipoprotein (LP) and apolipoprotein (apo) levels in healthy individuals. Material and methods. Twelve males without clinical or coronaroangiography signs of coronary heart disease (“healthy”) were examined. Participants underwent dynamical physical exercise (DPE) at veloergometer, with maximal (100%) and submaximal (80%, 70%, 60% of individual maximal tolerance level) workload. In other days, males underwent low-extremity static physical exercise (SPE), with maximal (100 kg; 100%) or submaximal workload (70 and 60 kg; 70% and 60%, respectively). Results. DPE of high intensity (≥80%) and SPE of maximal (100 kg) to moderate (60 kg) intensity resulted in atherogenic changes of blood lipid transport system: total cholesterol, low-density lipoprotein cholesterol, triglycerides, apoB levels, and apoLP atherogenity index (apoB/apoAI) increased. High-intensity SPE caused more severe and stable atherogenic dyslipoproteinemia, than DPE of similar intensity. DPE of 70% intensity was borderline for antiatherogenic effect on blood LP and apo profiles. Moderate DPE (60%) resulted in antiatherogenic dynamics of lipid transport system, decreasing apoB LP and increasing apoAI levels. Conclusion. Moderate-level DPE can be included into complex prevention of atherosclerosis in healthy individuals. Lower-extremity SPE (≥60 kg), as a component of strength training programs, can be combined with moderate-level DPE, to prevent post-exercise atherogenic dyslipidemia.

Parameters of lipid transport system as well as that of haemostasis have been studied in coronary heart disease (CHD) patients (n = 70) having at least one of two major CHD risk factors - arterial hypertension (AH) and dyslipoproteinemia (DLP). Patients with combination of AH and DLP significantly differed from those with isolated DLP by higher levels of total and low density lipoprotein cholesterol, triglycerides and apolipoprotein B. As compared with patients with isolated AH they differed by elevated systolic and diastolic blood pressure. The increased blood thrombogenicity (combination of disturbances in haemostasis resulted in enhanced thrombosis) was high both in hypertensive and dyslipidemic subjects. However, while in group with isolated DLP there was a predominance of decreased anticoagulation and fibrinolysis, in patients with isolated AH the major impact was related to elevated platelet aggregation. Thus, unfavorable shifts in lipoprotein and haemostasis parameters found in patients with AH and DLP could be regarded as markers of their atherothrombogenicity.

Cardiac rehabilitation in Russia – odds and perspectives.

Ключевой концепцией современной кардиологии в области профилактики и лечения сердечно-сосудистой патологии является концепция так называемых факторов риска (ФР) сердечно-сосудистых заболеваний (ССЗ). Среди них рассматриваются традиционные факторы внешней и внутренней среды связанные с частотой ССЗ и новые ФР. Атеросклероз, как основа ССЗ, несомненно, является многофакторным заболеванием. Влияние перечисленных факторов многопланово, они присутствуют у конкретного пациента в различных сочетаниях и вариируют по выраженности. Современная наука обладает огромной доказательной базой, свидетельствующей, что эндотелий сосудов и его многообразные функции являются мишенью этих неблагоприятных воздействий. Именно эндотелий -, не только монослой клеток, обеспечивающий текучесть крови, выстилающий всю кровеносную систему, но и паракринная ткань, участвующая в тромбогенезе, вазорегуляции, воспалении, является ключевым звеном в патогенезе артериальной гипертензии, атеросклероза и сахарного диабета. Значение дисфункции эндотелия (ДЭ) определяется: 1)Системно-стью ДЭ 2)Связью ДЭ с известными ФР, 3)Ролью ДЭ как медиатора и независимого предиктора СС событий 4) Клинической значимостью улучшения ДЭ для прогноза ССЗ. Именно поэтому стратификация сердечно-сосудистого риска, основанная на определении функции эндотелия является очень заманчивой и многообещающей. Именно дисфункция сосудистого эндотелия является тем недостающим звеном, которое связывает воедино все факторы сердечнососудистого риска и, очевидно, является суррогатным инструментальным критерием ремоделирования сердечнососудистой системы. Существуют так называемые эндотелиальные маркеры, концентрация и активность которых может быть определена в крови пациента. Среди них оксид азота, эндотелин, тромбомодулин, молекулы клеточной адгезии и т. д. Но гораздо более целесообразным является неинвазивное тестирование не изолированного показателя, а процесса, контролируемого сосудистым эндотелием. Например, определение вазорегулирующей функции эндотелия в ишемическом тесте верхней конечности. Среди методов оценки степени вазодилатации, определяемой функцией эндотелия используется ультразвуковой метод, пальцевая артериальная тонометрия, лазерная флюоме-трия. В значительной степени внедрение этих методик сопряжено с большими затратами и трудностями стандартизации. Нами предложено использование методики компьютерной фотоплетизмографии для оценки вазодилатации в ходе ишемического теста, предложен диагностический показатель функции эндотелия, определяемый как степень уменьшения относительной амплитуды отраженной волны. Клиническая ценность данной методики определена у пациентов с традиционными ФР, а также у больных с гипертонической болезнью, гестационной гипертензией, метаболическим синдромом, ИБС. Данный метод воплощен в компьютерной фотоплетизмографе «ЭЛДАР», разработанном и выпускаемом серийно инженерно-медицинским центром «Новые приборы». Наш опыт свидетельствует о том, что предлагаемый метод является простым, малозатратным и эффективным в решении актуальной задачи определения вазорегулирующей функции периферических артерий и их эластических свойств. Однако, возможность использования его для стратификации СС риска должна быть установлена в многоцентровом исследовании, спланированном на принципах доказательной медицины.

Based on СОURAGE study results (Clinical Outcomes Utilizing Percutaneous Coronary Revascularization and Aggressive Guideline-Driven Drug Evaluation), modern tactics for management of patients with coronary heart disease (CHD) and stable angina are discussed (percutaneous coronary intervention, PCI, or aggressive drug therapy with statins, aspirin, ACE inhibitors etc.). The role of secondary drug prevention, according to modern guidelines, is highly appraised. The emphasis is put on the leading role of lipid-lowering therapy with statins and ezetimibe. No significant difference was observed for complication rates in PCI group (n=1149) and optimal drug therapy (n=1138). Cumulative incidence of primary events during 4,6 years of follow-up was 19,0% and 18,5% in PCI and drug therapy groups, respectively (р=0,62). Therefore, in patients with stable CHD, PCI as a first-line strategy does not reduce the risk of death, myocardial infarction, or cardiovascular events, if combined with drug treatment.

Aim. To study the prevalence of choleretic system pathology in patients with coronary heart disease (CHD) and recent acute coronary events; to assess the effects of the long-term, moderate-intensity physical training (PT) programme on the gallbladder (GB) function, lipid metabolism, and exercise capacity (EC). Material and methods. First, the prevalence of gastrointestinal symptoms was assessed in CHD patients with recent acute coronary events. Second, 85 patients with concomitant GB dysfunction were randomised into the main group (MG; n=43) receiving moderate-intensity PT, or the comparison group (CG; n=42). The intervention effectiveness was assessed by the clinical, functional, and biochemical parameters at baseline and 12 months later. All patients received standard pharmaceutical treatment, as required. Results. Gastrointestinal symptoms were reported by 81 % of the patients, including 75,9 % with hypotonic-hypokinetic GB dysfunction. The six-minute walk test distance increased. After the PT course, the GB volume decreased from 37,5±2,7 to 27,3±2,1 ml in the MG, and did not change in the CG. GB dysfunction prevalence decreased by 62,7 % in the MG and increased by 3,1 % in the CG. Conclusion. In CHD patients after acute coronary events, the prevalence of GB dysfunction was 78,9 %. The longterm, moderate-intensity PH programme, combined with standard pharmaceutical therapy, improved EC, reduced angina attack incidence, and normalised GB motoric function and serum lipid profile in CHD patients with concomitant GB dysfunction.

To assess the dynamics of physical activity (PA) in patients with coronary heart disease (CHD) during rehabilitation or secondary prevention, a specialised questionnaire ODA23+ was developed. This instrument takes into account the specifics of Russian patients’ lifestyle and mentality, assesses PA levels, and evaluates PA dynamics over time. The mathematical model was created, based on experts’ opinions. After statistical analysis of the data obtained from experts, point-based weights for each answer to all 23 questions were determined. The questionnaire ODA23+ was assessed in two clinical studies of rehabilitation and secondary prevention among CHD patients after acute coronary incidents, coronary artery bypass graft surgery, or coronary endovascular intervention. It was demonstrated that the questionnaire is valid and sensitive in the dynamic assessment of PA. The questionnaire also provides an opportunity to compare the long-term effectiveness of different physical training or educational programs in CHD patients.