RESUMEN
Aim To study the condition of coronary vasculature by data of coronarography (CG) in patients with chronic ischemic heart disease (IHD) and arterial hypertension (AH) associated with stage 2-4 chronic kidney disease (CKD) and to evaluate the effect of a 12-week complex treatment with perindopril or with a combination of perindopril/amlodipine on changes in vascular wall stiffness, endothelial function, and structure and function parameters in this patient category after coronary stenting.Material and methodsr This study included 87 patients with chronic IHD and AH associated with stage 2-3 CKD for whom CG was performed due to ineffectiveness of the antianginal therapy. The patients were divided into three subgroups: subgroup 1 included 28 patients who received a conservative treatment with perindopril 10 mg/day; subgroup 2 consisted of 25 patients who underwent coronary stenting and were prescribed perindopril; subgroup 3 consisted of 34 patients who underwent stenting and were prescribed the perindopril/amlodipine combination. The reference group included 47 patients with IHD and AH with preserved kidney function. Anatomic and functional parameters of the heart, arterial stiffness, pulse wave velocity, cardio-ankle vascular index, augmentation index, central aortic systolic and pulse pressure, endothelium-dependent vasodilation, plasma concentration of endothelin-1 (ET-1), and plasma concentration of nitric oxide metabolites were evaluated at baseline and after 12 weeks of treatment.Results In patients with IHD, AH, and stage 2-3 CKD, arterial stiffness was more pronounced than in patients with preserved kidney function. Concentrations of ET-1 were significantly higher and levels of nitric oxide were lower in CKD. Supplementing the complex therapy with perindopril resulted in a considerable hypotensive effect in all subgroups, improvement of the kidney function, and positive dynamics of arterial stiffness and endothelial function. Changes in these parameters were more pronounced in patients after coronary stenting than in patients receiving only a conservative treatment. The use of perindopril/amlodipine following stenting exerted the most significant angioprotective and cardioprotective effect.Conclusion Patients with IHD and AH in combination with early CKD have pronounced impairment of the condition of arterial blood vessels and the heart. Addition of perindopril to the treatment not only exerted a hypotensive effect but also beneficially influenced mechanisms of progression of this combined pathology.
Asunto(s)
Enfermedad Coronaria , Hipertensión , Insuficiencia Renal Crónica , Amlodipino/farmacología , Antihipertensivos/uso terapéutico , Presión Sanguínea , Enfermedad Coronaria/tratamiento farmacológico , Combinación de Medicamentos , Humanos , Hipertensión/tratamiento farmacológico , Perindopril , Análisis de la Onda del Pulso , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/tratamiento farmacológicoRESUMEN
In rats with experimentally formed arterial hypertension, lipid perxidation in the plasma, amplification of blood chotting mechanisms with a decrease in anticoagulation and fibrinolysis was noted. Regular forced jogging provided the experimental rats with a positive dynamic of all the indicators considered. Thus, with increased muscular activity, the level of acyl hydro-peroxides of plasma decreased in rats with arterial hypertension formed due to the enhancement of its antioxidant activity. In addition, with the increase in muscle activity in experimental rats, normalization of clotting factor activity, indices of general coagulation tests, antithrobin III activity and protein C was achieved. This was accompanied by a normalization of the level of plasminogen, a2-antiplasmin and spontaneous euglobulin lysis time. In rats with formed arterial hipertension with stgandard physical activity, the initial violations of the measured parameters were completely preserved (AU)
Asunto(s)
Ratas , Coagulación Sanguínea , Experimentación Animal , Hemostasis , Homeostasis/fisiología , Hipertensión , Actividad MotoraRESUMEN
Taking into account the genetic heterogeneity of hyperlipidemias, polymorphic genes involved in the regulation of lipid metabolism may explain differences in the efficacy of hypolipidemic therapy. In the present prospective and randomized study, we have investigated the efficacy of rosuvastatin (10 mg/day) in the therapy of atherogenic hyperlipidemias in a group of 62 patients with coronary heart disease (CHD), depending on the genotype of lipoprotein lipase (LPL). The pharmacological correction was carried out during one year under control of lipid metabolism parameters (total cholesterol, LDL-C, HDL-C, HDL-unrelated cholesterol, triglycerides, atherogenic index) at the baseline and on 4th, 8th, 24th and 48th week. The HindIII polymorphism (+495T > G, rs320) of the LPL gene was genotyped in all patients studied through a real-time PCR TaqMan assay. Rosuvastatin produced a significant hypolipidemic effect with respect to all investigated lipid metabolism parameters for 24 weeks of treatment. Changes in the parameters of lipid metabolism upon rosuvastatin treatment differed in patients with genotype +495GG as compared to the rest LPL genotypes. In comparison to the +495TT and TG genotypes, the genotype +495GG showed a greater reduction in total cholesterol on 8th week, and in LDL-C, HDL-unrelated cholesterol, and atherogenic index on the 48th week of rosuvastatin therapy (p <0.01). It can be suggested that the pronounced hypolipidemic effect of rosuvastatin in homozygotes +495GG of the LPL gene is associated with modulation of the LPL activity, as it has been previously reported for other statin drugs.
Asunto(s)
Enfermedad Coronaria , Hiperlipidemias , Lipoproteína Lipasa/genética , Polimorfismo de Longitud del Fragmento de Restricción , Rosuvastatina Cálcica/administración & dosificación , Adulto , HDL-Colesterol/sangre , HDL-Colesterol/genética , LDL-Colesterol/sangre , LDL-Colesterol/genética , Enfermedad Coronaria/tratamiento farmacológico , Enfermedad Coronaria/enzimología , Enfermedad Coronaria/genética , Humanos , Hiperlipidemias/tratamiento farmacológico , Hiperlipidemias/epidemiología , Hiperlipidemias/genética , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
It is well known now that hypolipidemic therapy is able to inhibit development of atherosclerosis. This decreases the rate of coronary complications. However, the problem of adequate pharmacotherapy duration has not been solved yet, as long-term treatment may provoke side effects. This study compared efficacy of hyperlipidemia (HLE) correction by long-term hypolipidemic diet (HD) and pharmacotherapy (PT) in patients with ischemic heart disease (IHD). 93 HLE patients with IHD aged 50-65 years entered the study. Enduracin used for 16-24 weeks (Endurance Products Company, USA) in a dose 1500 mg/day has reduced cholesterol by 15.7%, low density lipoproteins--by 19.2%, triglycerides--by 26%. High density lipoproteins rose by 15.7%. Besafibrat (Germany) in a dose 600 mg/day is indicated for patients with isolated hypertriglyceridemia (reduced triglycerides by 41.2%). Enduracin is indicated for patients with moderate levels of atherogenic serum lipids in isolated and combined HLE if fibrates are contraindicated. Diet lowered LDLP and VLDLP insignificantly and did not change HDLP. Prolongation of diet did not enhance the effect this allowing using diet therapy as background treatment.