Aim. To evaluate the therapeutic efficacy of a combination of ivabradine and beta-blockers (BAB) in patients with stable angina, initially taking only BAB and not reaching the target heart rate (HR) due to the risk of hypotension.Material and methods. A prospective observational post-registration study was performed at the Research Institute for Complex Issues of Cardiovascular Diseases. The study included 50 patients with stable angina pectoris (diagnosed by coronary angiography in combination with clinical manifestations of angina of functional class II-III according to the Canadian classification) and an initial sinus rhythm with a heart rate of more than 70 beats per minute. These patients have already taken BAB. Heart rate, the number of angina attacks, nitrate intake and quality of life indicators according to the questionnaire were evaluated as criteria for therapeutic efficacy.Results. Taking the study drug in combination with BAB led to a significant decrease the average heart rate at rest by 20%, as well as after a six-minute walk test (TLC) in most patients (p<0.050), and a decrease in the total number of angina attacks per week from 5 to less than 1 (p<0.050) and the frequency of nitrate intake for the relief of angina attacks from 58% to 20% (p=0.001). Therapy with ivabradine (Bravadin) was well tolerated by patients: there were no adverse events in the observed sample of patients, patients had a high adherence to treatment (100% of the contents of handed out blisters were used). During the 3 months of follow-up, according to the EQ-5D-5L quality of life questionnaire, patients improved their perception of their own health level (p<0.050), the number of patients experiencing mild (p=0.034) and strong (p=0.041) mobility limitations decreased; strong (p=0.024) restriction in self-care, mild (p=0.041) and strong (p=0.024) restriction of daily activities, mild manifestation of pain (p=0.009) and mild anxiety (p=0.027) also were reduced compared with the initial questionnaires.Conclusion. Ivabradine (Bravadin) in addition to BAB is an effective and safe antianginal therapy for the prevention of angina attacks by reducing the initially high heart rate in patients with angina pectoris of functional class II-III.
Aim. To study the prevalence of musculoskeletal disorders in patients with stable coronary artery disease (CAD).Material and methods. Patients with stable CAD (n=387) were included in the study. The subjects were admitted to the hospital for planned myocardial revascularization (ages of 50-82). The median age was 65 [59;69] years. Most of the sample consisted of males - 283 (73.1%). 323 (83.5%) patients had arterial hypertension (AH), 57.1% - history of myocardial infarction, and a quarter of the patients had type 2 diabetes mellitus (DM). The study of musculoskeletal system included the identification of sarcopenia in accordance with The European Working Group on Sarcopenia in Older People (EWGSOP, 2019); verification of osteopenia/osteoporosis according to the WHO criteria (2008); diagnosing osteosarcopenia in case of sarcopenia and osteopenia/osteoporosis coexistence.Results. At the initial screening of sarcopenia in accordance with EWGSOP, clinical signs (according to the Strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire) were detected in 41.3% of cases, but further examination (dynamometry, quantitative assessment of skeletal muscle) confirmed this diagnosis only in 19.9% of patients with CAD. Among the examined patients with CAD a low T-score according to DEXA was found in 53 (13.7%) of cases, and osteopenia was diagnosed 10 times more often than osteoporosis (90.6% vs. 9.4%). Furthermore, due to combination of low bone density (osteopenia/osteoporosis) and reduced muscle mass and strength (sarcopenia), osteosarcopenia was verified in one patient. Thus, the study revealed the prevalence of particular types of musculoskeletal disorders in 105 (27.1%) patients with stable CAD. The most common type of musculoskeletal disorder was sarcopenia - 52 cases (13.4%); osteopenia/osteoporosis was detected in 28 patients (7.2%), osteosarcopenia in 25 (6.5%). The most pronounced clinical manifestation of sarcopenia and osteopenia/osteoporosis, reflected by a higher score on the SARC-F questionnaire, low handgrip strength, small area of muscle tissue, low musculoskeletal index, as well as low values of bone mineral density, were observed in patients with osteosarcopenia. Patients with osteopenia/osteoporosis did not differ significantly from patients without musculoskeletal conditions in most parameters, with the exception of the T-score, the average SARC-F score, and muscle strength in men. The conducted correlation analysis revealed not only the relationship between the parameters of musculoskeletal function, but also their association with age, duration of AH, CAD, and type 2 DM.Conclusion. Several types of musculoskeletal disorders were found in a third of patients with CAD. Sarcopenia was revealed to be the most frequent type of musculoskeletal disorder.
The review discusses the results of various clinical studies assessing the impact of physical activity on the cardiovascular system and provides the evidence suggesting that physical inactivity along with psychosocial factors, i.e. smoking, excessive alcohol consumption, unhealthy diet, obesity, arterial hypertension, diabetes, is one of the most significant risk factors leading to the development of cardiovascular disease. The comparative assessment of the indicators of cardiovascular morbidity and mortality adjusted to the level of physical activity and gender in the countries with different socioeconomic development is presented. Thus, there is a need to increase adherence to the recommended levels of physical activity in order to reduce cardiovascular morbidity, overall and cardiovascular mortality in the countries with different income levels.
ФГБНУ Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний. Кемерово; 2 ФГБОУ ВО Кемеровский государственный медицинский университет Минздрава России. Кемерово, РоссияПитание является важнейшей составляющей лечебных и профилак тических мероприятий при сердечнососудистых заболеваниях. В настоящее время рассматриваются разные диеты, как для про филактики ожирения, так и для снижения риска тяжелой кардиова скулярной патологии. В большинстве стран проводятся работы по изучению различных диетических моделей среди населения. В данной статье представлен обзор крупных эпидемиологических исследований, посвященных вопросам влияния питания на кардио васкулярную патологию. Обсуждаются задачи и основные резуль таты, сильные и слабые стороны представленных работ. Nutrition is a crucial element of patient management in cardiovascular disorders. Recently, a variety of diets considered, for prevention of obesity as for risk reduction of severe cardiovascular pathology. In most countries there are ongoing studies on various diet models among the population. The review is focused on the range of large epidemiological trials of nutrition in cardiovascular pathology. The tasks discussed and the main results, stronger and weaker aspects of the works represented.
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