We investigated the heart rate variability (HRV) parameters in patients with rheumatoid arthritis (RA) and assessed their relationship with disease characteristics. Twenty-three female patients with RA [age 48+/-7 (mean+/-SD) years] free of cardiovascular diseases and 23 age- and gender-matched healthy controls were evaluated. After careful clinical examination, the following parameters were obtained after 24-h Holter recordings: average of all normal-to normal (NN) intervals over the entire 24-h ECG recording (meanNN, ms); the standard deviation for the time between NN complexes (SDNN, ms); the standard deviation of the average NN intervals for each 5-min period (SDANN, ms) and the square root of the mean-squared differences of successive NN intervals (rMSSD, ms). We also assessed quantitative parameters of the Poincaré plot: the standard deviation of the points perpendicular to the line-of-identity (SD1, ms); the standard deviation along the line-of-identity (SD2, ms) and their ratio (SD12). HRV parameters excluding SD2 were significantly lower in patients with RA, than in control group (p<0.05). Significant correlations of SDNN and SDANN with swollen joints count, Ritchie articular index, disease activity score (DAS) and disease duration were found. SDNN also correlated with leucocyte count and smoking. SD1 significantly correlated only with disease duration. Relationships between SDNN and smoking, swollen joints count and DAS were confirmed using multivariate analysis. Our data indicate that in patients with RA reduced HRV is independently associated with high disease activity and smoking. HRV assessment may be useful as a part of cardiovascular risk stratification in RA patients.
Rilmenidine has similar effects on ambulatory BP patterns in hypertensive women with metabolic syndrome as lisinopril. Rilmenidine compared with lisinopril significantly reduces ambulatory HR. In this study, rilmenidine and lisinopril demonstrate similar effects on plasma lipid and fasting glucose levels.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used pain relievers. However, their use often threatens with serious undesirable effects, associated mainly with damage to cardiovascular system (CVS), gastrointestinal tract, kidneys and liver. Contraindications to NSAIDs prescription are clearly regulated, algorithms for their personalized appointment are determined taking into account risk factors for cardiovascular and gastrointestinal adverse events. The severity of NSAIDs side effects is mainly due to the selectivity to cyclooxygenase-2 (COX-2), as well as the physicochemical properties of various drugs. Cardiovascular adverse events differ among various NSAIDs both within commonly used drugs and among COX-2 inhibitors. It is well known that NSAIDs selective for COX-2 are safer in terms of the effect on the gastrointestinal tract than non-selective drugs. A meta-analysis showed that relatively selective COX-2 inhibitors (meloxicam, etodolac) were associated with a comparable risk of developing symptomatic ulcers and ulcers identified by endoscopy, and safety and tolerability profiles of the drugs were similar.All NSAIDs are associated with cardiovascular toxicity, however, different drugs have significant risk differences. The mechanism of NSAIDs cardiovascular adverse effects is associated with an increase of blood pressure, sodium retention, vasoconstriction, platelet activation, and prothrombotic state. It has been shown that the risk of cardiovascular adverse events when taking COX-2 inhibitors (celecoxib, etoricoxib) significantly increases. According to a study of more than 8 million people, it was found that the risk of myocardial infarction was increased in patients taking ketorolac. Further, highest to lowest risk authors list indomethacin, etoricoxib, rofecoxib (not currently used), diclofenac, a fixed combination of diclofenac with misoprostol, piroxicam, ibuprofen, naproxen, celecoxib, meloxicam, nimesulide and ketoprofen. When taking NSAIDs, the risk of heart failure decompensation increases, and it turned out to be the greatest for ketorolac, etoricoxib, and indomethacin. Meloxicam, aceclofenac, ketoprofen almost did not increase heart failure risk. It should be noted that when using the drugs (except for indomethacin and meloxicam), there is a tendency to increase the total cardiovascular and renal risks with increasing doses. Thus, it is obvious that a very careful approach is required when choosing NSAIDs. If there is an increased risk of gastrointestinal complications associated with NSAIDs, selective NSAIDs are preferred, with both coxibs and traditional selective NSAIDs showing the best safety profile in the studies. To minimize cardiovascular side effects specialists should consider the risk level of cardiovascular complications, as well as results of large clinical studies where particular NSAIDs are compared.
Dual antiplatelet therapy (acetylsalicylic acid and platelet P2Y12 receptor antagonist) is a standard component of treatment of any type of acute coronary syndrome, independently of perfusion and the chosen treatment strategy. Due to certain limitations of clopidogrel as the 2nd component of dual antiplatelet therapy in patients with acute coronary syndrome and percutaneous coronary intervention, the possibility of using prasugrel or ticagrelor should be considered first. Their effectiveness is higher than clopidogrel’s, as was demonstrated in large clinical trials. As a result, prasugrel and ticagrelor were included in all major international and Russian guidelines on treatment of this category of patients with the same class and level of evidence. Currently, there’re no data from any finished large randomized clinical trials of sufficient statistical power directly comparing the effectiveness and safety of prasugrel and ticagrelor. Therefore, careful analysis of the accumulated data on the safety and effectiveness of each drug including meta-analyses and registries is necessary for providing the best care for every individual patient.
Цель. Изучить влияние дополнительного назначения бетагистина дигидрохлорида к терапии ингибитором АПФ при симптомах головокружения у больных хронической сердечной недостаточностью (ХСН) II-III функционального класса (ФК). Материал и методы. В рандомизированное открытое параллельное исследование включен 61 больной (36 мужчин и 25 женщин) ХСН II-III ФК (NYHA) с фракцией выброса ≤45% (по Simpson), имеющий симптомы головокружения. Пациенты рандомизированы в 2 группы. В обеих группах проводили титрацию эналаприла с 5 мг (или с дозы, принимаемой пациентом до исследования) до целевой-20 мг/сут (для больных с АД>140/90 мм рт.ст. целевую дозу эналаприла увеличивали до 40 мг/сут). В группе активного лечения к терапии эналаприлом добавляли бетагистина дигидрохлорид 24 мг 2 раза в день. Во время первого и завершающего визитов заполняли анкеты по оценке качества жизни и выраженности симптомов головокружения. Всем больным регистрировали ЭКГ в покое. На каждом визите проводили опрос, общий осмотр с оценкой параметров гемодинамики (артериального давления, частоты сердечных сокращений), учет препаратов, регистрацию нежелательных явлений. Результаты. Целевой (≥20 мг в сут) дозы ингибитора АПФ удалось достичь у 52 из 54 пациентов. Это привело к статистически значимому уменьшению выраженности одышки, отеков, снижению ФК ХСН, повышению качества жизни. Статистически значимых отличий между исследуемыми группами не было. Продемонстрировано уменьшение симптомов головокружения в обеих группах. В группе бетагистина дигидрохлорида выявлено большее повышение баллов по шкале, определяющей настроение (не достигшее статистической значимости, р=0,08). Была обнаружена тенденция к более успешной возможности достижения целевого уровня ингибитора АПФ при дополнительном назначении бетагистина дигидрохлорида. У 2-х пациентов в группе контроля не удалось достичь целевой дозы эналаприла в связи с развитием побочных эффектов проводимой терапии ХСН. Заключение. Достижение целевой дозы ингибитора АПФ возможно более чем у 90% больных ХСН II-III ФК без возникновения симптомов гипотонии. Дополнительное назначение бетагистина дигидрохлорида необходимо при остающихся симптомах головокружения после достижения целевой дозы ингибитора АПФ у больных ХСН.
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