Funding Acknowledgements Type of funding sources: None. Aim of the study To establish the incidence of premature ventricular contractions among individuals with high and very high risk of cardiovascular diseases. Materials and methods During the period between 2007-2013 a total of 4,214 individuals were examined, age ranged from 35 to 85 years. Each individual underwent 24-hour Holter monitoring. All participants of the study were divided into groups: 1-st - patients with coronary artery disease (mainly stable angina), but without accompanying risk factors for cardiovascular diseases, such as smoking and obesity (n=234); 2nd group - people who smoked 5 or more cigarettes per day for more than 2 years (n=144); 3rd group - obese people without concomitant coronary artery disease and arterial hypertension (n=197); 4th group - people with obesity and hypertension (n=187). The control group included 149 practically healthy people. The groups were statistically homogenic in age and gender. The incidence of premature ventricular contractions in was following according to V. Lown and M. Wolf classification: the 1st group – I - 16 (6,83%), II - 23 (9,82%), III - 2 (0,85%), IV - 13 (5,55%), V - 18 (7,69%); the 2nd group - 14 (9,72%), II – 10 (6,95%), III - 5 (3,47%), IV - 28 (19,44%), V - 13 (9,02%); the 3rd - I - 1 (7,61%), II - 6 (3,04%), III - 3 (1,52%), IV - 21 (10,65%), V - 13 (6,6%), the 4th - I - 22 (11,76%), II - 13 (6,95%), III - 2 (1,07%), IV - 24 (12,83%), V - 8 (4,27%). The lowest incidence of this arrhythmia was observed among patients with stable angina - 30,34%. This can be explained by patients being more thoroughly supervised by doctors and higher compliance for treatment. Another reason was that groups 2-4 included people with only risk factors, and group 1 - people with the coronary artery disease. Among obese people with and without hypertension, the incidence of this arrhythmia was almost the same – 35,1% and 36,7%, respectively, and was not significantly different from control group (33,6%). Therefore, analyzing the data presented above, we established that people who smoke tobacco have higher incidence of ventricular premature contractions than in healthy individuals and people with obesity and hypertension. There was observed no statistically significant difference in the incidence of ventricular premature contractions in individuals with isolated obesity or obesity concomitant with arterial hypertension.
Dyslipidemia is an important problem for family doctors, as it is a risk factor for the development of atherosclerotic cardiovascular diseases (ACVD). ACVD is the cause of more than 4 million deaths in Europe today. Women in this sad statistic are 2.2 million, and men - 1.8 million. It is expected, that mortality due to cardiovascular diseases in men aged up to 65 years is significantly higher than in women (430 thousand and 193 thousand, respectively). The ESC/EAS-2019 (European Society of Cardiology / European Society of Atherosclerosis) updated guidelines on the management of people with dyslipidemia (DLP) provide specific recommendations that can be used by family doctors in Ukraine in their daily preventive and curative work. The ESC/EAS-2019 (European Society of Cardiology / European Society of Atherosclerosis) and the Ukrainian Society of Atherosclerosis (USA) guidelines emphasize that the cornerstone of the prevention and treatment of ACVD is primarily the detection and correction of DLP. The prevalence of DLP in Ukraine is about 20%. At the same time, for effective correction of DLP it is important to verify the type of dyslipidemia, isolate genetically determined forms of dyslipidemia (familial hypercholesterolemia), establish cardiovascular risk, select the most effective measures of lifestyle modification and formulate therapeutic goals of prevention / treatment. In the treatment of DLP apart from lifestyle modification, the drugs of choice are statins in high-intensity doses. Ezetimibe and PCSK-9 inhibitors can be used in addition to statin therapy in case of its ineffectiveness or side effects. It was found, that resistance to statins and their intolerance is the basis for the use of non-statin hypolipidemic drugs (nutraceuticals), among which the most studied are ω-3 PUFA and phytosterols. The ESC / EAS (2019) guidelines state that consumption of ω-3 PUFAs is associated with a lower risk of death from CVD and stroke. It was noted, that the mechanism of reducing TG levels under the influence of ω-3 PUFA may be related to their ability to interact with PPAR (receptors that activate the proliferation of peroxisomes) and reduce the secretion of apoprotein B. Recent clinical studies confirm the need for high doses of highly purified form of ω-3 PUFA for patients with elevated TG levels, despite treatment with statins. Another non-statin drug that reduces LDL levels is bempedoic acid. Studies have shown a significant reduction in LDL levels in patients receiving additional bempedoic acid. The effectiveness of bempedoic acid as a monotherapy of DLP is now being studied. This review presents new data on the effectiveness of the combination of sugar cane extract policosanol with ω-3 PUFA (docosahexaenoic acid 10%). The drug of this composition "Cardioneurin" is present on the pharmaceutical market of Ukraine. Clinical studies have shown, that in case of resistance or intolerance to statins, especially in high doses, a hybrid strategy of lipid-lowering therapy can be used - a combination of low-intensity doses of statins with a combined nutraceutic "Cardioneurin". This treatment reduces the level of atherogenicity by 22%, which gives grounds for its use in the practice of family doctors. Other forms of policosanol (other than sugar cane), such as those derived from beeswax or wheat germ, do not have an adequate evidence base. Thus, dyslipidemia is the primary and main factor in the development of ACS, it in most cases occurs long before the emergence of other important risk factors and may even be a prerequisite for their occurrence. Epidemiological evidence suggests, for example, that DLP may in itself be a risk factor for STEMI / NSTEMI and unstable angina.
Multi-vessel coronary artery disease is quite a common state, which is often diagnosed by coronary angiography in patients with both stable coronary artery disease and acute coronary syndromes. Major difficulties in percutaneous coronary intervention include stent thrombosis and the need for antiplatelet therapy (aspirin and a P2Y12 inhibitor). Stent thrombosis leads to the recurrence of myocardial infarction and may occur within the first few hours after percutaneous coronary intervention. The use of dual antiplatelet therapy, especially that combined with low-molecular-weight heparin in the first days after myocardial infarction, poses a risk of bleeding, which often occurs in real clinical practice. Among P2Y12 inhibitors, ticagrelor causes bleeding somewhat more frequently than clopidogrel. A case of multi-vessel coronary artery disease is described in this paper. Coronary angiography revealed right-dominant circulation; occlusion of the proximal and medial segments of the right coronary artery, thrombolysis in myocardial infarction flow grade 0; stenosis of the left main coronary artery (50-60%), thrombolysis in myocardial infarction flow grade 2; diffuse stenosis of the medial and distal segments of the left anterior descending artery, thrombolysis in myocardial infarction flow grade 1; stenosis of the proximal segment of the left circumflex artery (> 75%), thrombolysis in myocardial infarction flow grade 1. The patient underwent percutaneous coronary intervention; the stents were implanted in the infarct-dependent right coronary artery. The clinical course was complicated by early stent thrombosis with subsequent thrombus extraction; a day later melena developed. Bleeding was stopped, the intensity of antithrombotic therapy was reduced: the combination of aspirin and ticagrelor was replaced by the combination of aspirin and clopidogrel. Six weeks after stenting of the infarct-dependent coronary artery, complete myocardial revascularization (hybrid intervention) was performed: coronary artery bypass grafting [the left internal mammary artery → the left anterior descending artery], coronary autogenous bypass grafting [the aorta → the right coronary artery and the aorta → the left circumflex artery]. The role of fractional flow reserve or instantaneous wave-free ratio-controlled complete myocardial revascularization techniques is discussed. The following algorithm for myocardial revascularization was used: percutaneous coronary intervention for the right coronary artery + coronary artery bypass grafting-3: the left internal mammary artery → the left anterior descending artery, the aorta → the left circumflex artery, the aorta → the right coronary artery.
It has been established that adenosine is a universal trigger of the processes of preparation (conditioning) of the myocardium for ischemic injury, which is confirmed by randomized clinical trials AMISTAD II, TIMI-4, TIMI-9B. Adenosine is included in the guidelines of the ESC Task Force (European Society of Cardiology) as a means of basic therapy, as a representative of the class of potassium channel stimulants (2019) [1]. However, the use of adenosine as an injectable form for intracoronary or intravenous administration is associated with a number of side effects - rapid degradation of the drug in the bloodstream, the need for careful monitoring of systemic hemodynamics (hypotension, tachy- or bradyarrhythmia, ventricular tachycardia, atrioventricular block), frequent development of undesirable gastrointestinal manifestations. All this prompted the search for an alternative form of adenosine use, which would allow wider use of the potentially beneficial effect of adenosine on ischemic pre- and post-conditioning in real medical practice. More recently, on the pharmaceutical market of Ukraine for the first time appeared a pharmacological agent - Advocard, as a drug with the ability to start the processes of pre- and post-conditioning, with sublingual (oral) form of application. Advocard is an original combined polypill drug with three components: adenosine-5-triphosphate-gluconate-magnesium (II) trisodium salt (magladen) – 18,6-29,25 mg, molsidomine – 0,3 mg and folic acid - 0,45 mg. Recommendations for the use of the Advocard in medical practice are based on the results of clinical studies, which proved that the oral (sublingual) form of adenosine is not only effective and appropriate, but also safe with long-term use. The therapeutic efficacy of Advocard in chronic coronary syndromes [stable, vasospastic, microvascular angina (pain of small coronary vessels), painless myocardial ischemia] and acute coronary syndromes (STEMI / NSTEMI, instability to stenocardia) before or immediately after coronary stenting is in counteracting the mechanisms of reperfusion injury. Clinical practice has shown that Advocard is appropriate for the prevention of NO-REFLOW after opening the epicardial coronary artery, even with the result of TIMI-3. Thus, the Advocard opens the prospect of improving the effectiveness of coronary interventions and is an adjunct to complete myocardial revascularization.
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