Antianginal Effects Research Articles

Alopurinol Versus Trimetazidina para o Tratamento da Angina: Ensaio Clínico Randomizado

Abstract Background Recently, it was demonstrated that allopurinol, a xanthine oxidase inhibitor, has cardiovascular and anti-ischaemic properties and may be a metabolic antianginal agent option.Objective: The objective of this study was to evaluate the antianginal effect of allopurinol as a third drug for patients with stable coronary artery disease (CAD). Methods This was a randomized clinical trial between 2018 and 2020 including patients with CAD who maintained angina despite initial optimization with beta-blockers and calcium channel blockers. The individuals were randomized 1:1 to 300 mg of allopurinol twice daily or 35 mg of trimetazidine twice daily. The main outcome was the difference in the angina frequency domain of the Seattle Angina Questionnaire (SAQ-AF). A probability (p) value < 0.05 was considered statistically significant. Results A hundred and eight patients were included in the randomization phase, with 54 (50%) in the allopurinol group and 54 (50%) in the trimetazidine group. Six (5.6%) individuals, 3 from each group, were lost to follow-up for the primary outcome. In the allopurinol and trimetazidine groups, the median SAQ-AF scores were 50 (30.0 to 70.0) and 50 (21.3 to 78.3), respectively. In both groups, the SAQ-AF score improved, but the median of the difference compared to baseline was lower in the allopurinol group (10 [0 to 30] versus 20 [10 to 40]; p < 0.001), as was the mean of the difference in the total SAQ score (12.8 ± 17.8 versus 21.2 ± 15.9; p = 0.014). Conclusion Both allopurinol and trimetazidine improved the control of angina symptoms; however, trimetazidine presented a greater gain compared to baseline. Brazilian Registry of Clinical Trials - Registration Number RBR-5kh98y

Meldonium Supplementation in Professional Athletes: Career Destroyer or Lifesaver?

Meldonium is a substance with known anti-anginal effects demonstrated by numerous studies and human clinical trials; however, it does not possess marketing authorization within the European Union, only in ex-Soviet republics. Since 2016, meldonium has been included by the World Anti-doping Agency (WADA) on the S4 list of metabolic modulators. In performance athletes, meldonium is now considered a doping agent due to its capacity to decrease lactate production during and after exercise, its capability to enhance the storage and utilization of glycogen, and its protective action against oxidative stress. Together, these attributes can significantly improve aerobic endurance, cardiac function, and capacityas well as shorten recovery times (allowing higher intensity training), thereby enhancing performance. The purpose of this review is to highlight the most important mechanisms underlying the protective effect of meldonium against mitochondrial dysfunction (MD), which is responsible for oxidative stress, inflammation, and the cardiac changes known as "athletic heart syndrome."Meldonium acts as an inhibitor of γ-butyrobetaine hydroxylase (BBOX), preventing the de novo synthesis of carnitine and its absorption at the intestinal level via the organic cation/carnitine transporter 2 (OCTN2) and directing the oxidation of fatty acids to the peroxisomes. The decrease in mitochondrial β-oxidation of fatty acids leads to a reduction in lipid peroxidation products that cause oxidative stress and prevent the formation of acyl/acetyl-carnitines involved in numerous pathological disorders. Given the recent findings of the potentially detrimental effects of prolonged high-intensity exercise on cardiovascular health and coronary atherosclerosis, there may be legitimate arguments for the justification of the use of substances likemeldonium as protective supplements for athletes.

Allopurinol versus Trimetazidine for the Treatment of Angina: A Randomized Clinical Trial.

Recently, it was demonstrated that allopurinol, a xanthine oxidase inhibitor, has cardiovascular and anti-ischaemic properties and may be a metabolic antianginal agent option.Objective: The objective of this study was to evaluate the antianginal effect of allopurinol as a third drug for patients with stable coronary artery disease (CAD). This was a randomized clinical trial between 2018 and 2020 including patients with CAD who maintained angina despite initial optimization with beta-blockers and calcium channel blockers. The individuals were randomized 1:1 to 300 mg of allopurinol twice daily or 35 mg of trimetazidine twice daily. The main outcome was the difference in the angina frequency domain of the Seattle Angina Questionnaire (SAQ-AF). A probability (p) value < 0.05 was considered statistically significant. A hundred and eight patients were included in the randomization phase, with 54 (50%) in the allopurinol group and 54 (50%) in the trimetazidine group. Six (5.6%) individuals, 3 from each group, were lost to follow-up for the primary outcome. In the allopurinol and trimetazidine groups, the median SAQ-AF scores were 50 (30.0 to 70.0) and 50 (21.3 to 78.3), respectively. In both groups, the SAQ-AF score improved, but the median of the difference compared to baseline was lower in the allopurinol group (10 [0 to 30] versus 20 [10 to 40]; p < 0.001), as was the mean of the difference in the total SAQ score (12.8 ± 17.8 versus 21.2 ± 15.9; p = 0.014). Both allopurinol and trimetazidine improved the control of angina symptoms; however, trimetazidine presented a greater gain compared to baseline. Brazilian Registry of Clinical Trials - Registration Number RBR-5kh98y.

PREDICTIVE FACTORS FOR ACHIEVEMENT OF TARGET SYSTOLIC BLOOD PRESSURE AND HEART RATE: SUB-ANALYSIS OF PRIDE STUDY

Objective: To define predictors for achievement of target systolic blood pressure (SBP) and heart rate (HR) in the PRIDE study (NCT03730116). Design and method: It was a 12-week ambispective observational study to assess antihypertensive and antianginal effectiveness of Bisoprolol/ Perindopril (Biso/Per) single-pill combination (SPC) in outpatients with coronary artery disease (CAD), history of myocardial infarction (MI) and arterial hypertension (HTN). This analysis aimed to evaluate predictive values of baseline (BL) demographic and clinical characteristics to achieve target SBP and HR in study population. Results: Of 481 included patients, 154 (32.0%) were female, mean age 61.4 (8.9) years. Prevalence of type 2 diabetes mellitus (T2D) at BL was 24.1%. Proportions of patients with Grade I, II, III or isolated HTN (ISH) and those with controlled HTN (BP&lt; 140/90 mm Hg) at BL were 55.3% (n=266), 10.8% (n=52), 5.0% (n=24), 5.0% (n=24), 23.9% (n=115), correspondingly. Mean duration of HTN and CAD were 12.8 (8.4) and 6.1 (6.3) years. Proportions of patients treated with 2,5/2,5, 5/5, 5/10 and 10/10 mg of Biso/Per SPC at BL were 12.1%, 33.5%, 34.3%, 20.2% correspondingly. Doses were changed in 1.6% of cases by week 12 of observation. At week 12, mean SBP, DBP and HR significantly decreased by 24.9 (16.4), 12.2 (11.0) mm Hg and 14.4 (11.7) bpm, respectively (p&lt; 0.001 for all). Multivariable analyses revealed grade III HTN at BL was the only significant negative predictor for achieving SBP&lt; 140 mm Hg, whereas grade III HTN, CAD with angina of functional class II and older age (more 65 y.o.) were negative predictors for achieving SBP &lt; or equal 130 mm Hg at week 12 of observation. Grade III HTN at or presence of T2D at BL decreased the likelihood of achieving target HR (55-60 bpm), according to the data given in Table 2. Conclusions: Grade III HTN, concomitant T2D and symptomatic angina were negative predictors for achievement of the target SBP and HR in patients with HTN and a history of MI. There were no positive predictors for achievement of the target BP and HR explored.

THE ADVANTAGES OF SYDNONIMINES COMPARED TO NITRATES IN THE TREATMENT OF PATIENTS WITH ISCHEMIC HEART DISEASE AND CORONARY INSUFFICIENCY

One of the primary challenges in treating patients with coronary artery disease and coronary insufficiency using nitrates is the development of tolerance. Nitrate tolerance is a condition in which the duration and intensity of anti-anginal and anti-ischemic effects decrease, despite maintaining a high concentration of the drug in the blood. In cases of developing tolerance, a continual increase in the nitrate dose is necessary to achieve the previous effect. To eliminate developed nitrate tolerance, discontinuing nitrates for 3-5 days is typically sufficient. Currently, molsidomine is employed as an alternative to nitrates, with sydnonimines emerging as a noteworthy substitute. Among sydnonimines, molsidomine (marketed as Sydnopharm, Dilasidom, Corvaton) stands out as the most effective. Despite its chemical distinction from nitrates, molsidomine operates through a similar mechanism. Functioning as a nitric oxide donor, this antianginal drug avoids the development of tolerance even with prolonged use. Molsidomine, akin to nitrates, acts as a vasodilator, exhibiting efficacy as an anti-ischemic and anti-anginal medication when administered in appropriate doses. Upon entering the human body, molsidomine undergoes hepatic metabolism, transforming into an active derivative compound known as SIN-1. This metabolite, upon entering the bloodstream, further converts into an active form (SIN-1A). From this active metabolite, the nitric oxide (NO) group is released, influencing the activation of guanylate cyclase. This activation prompts guanosine triphosphate to convert into cyclic guanosine triphosphate, ultimately contributing to the synthesis of proteins that bind calcium. This cascade of events results in the vasodilatory effect of molsidomine. Indications for molsidomine include stable angina pectoris, acute coronary syndrome, early post-infarction angina, congestive heart failure, portal hypertension, pulmonary hypertension, and Aerz's disease. Possible side effects following the therapy with molsidomine (dizziness, headache, and diplopia) occur much less frequently compared to nitrates. After using nitrates, such a side effect as methemoglobinемia may occur. Therapy with molsidomine does not lead to the development of this side effect.

ЭФФЕКТИВНОСТЬ ФИЗИОТЕРАПИИ У РАБОТНИКОВ РЕЧНОГО ТРАНСПОРТА, ИМЕЮЩИХ ДОКЛИНИЧЕСКИЕ СТАДИИ СЕРДЕЧНО-СОСУДИСТЫХ ЗАБОЛЕВАНИЙ, И ФАКТОРЫ РИСКА ИХ РАЗВИТИЯ

Aim. The primary objective of this study was to evaluate the effect of physical therapy on blood pressure, dyslipidemia, the level of somatic and mental health, and cardiovascular risk in river transport workers with preclinical stages of cardiovascular disease and risk factors for their development. Methods. Sixty-two employees of JSC "Tomsk Shipping Company" who were divided into 2 groups were studied. The first group consisted of riverboat workers with risk factors for cardiovascular disease, and the second group included workers with preclinical stages of cardiovascular disease and risk factors for their development. In the river transport crew, the correction of the main risk factors for cardiovascular disease was carried out following the DASH diet, moderate physical activity, application of physical factors, preventive talks, and biofeedback training. In preclinical forms of cardiovascular disease (AH of the 1st degree), complex hypotensive therapy was also applied. To study the effectiveness before and after physical therapy, BP was recorded, the level of somatic health and psychoemotional status was evaluated, the adaptation potential was calculated, the contents of total cholesterol and low density lipoprotein cholesterol, as well as absolute or relative cardiovascular risk were determined. Results. Therapeutic and prophylactic measures allow to increase adaptation and psychological capabilities of rivermen, to normalize blood pressure in all workers of the river transport crew under 40 years old, to reduce the degree of arterial hypertension in workers over 40 years old, to reach target values of total cholesterol and low density lipoprotein cholesterol in 18% of cases, to increase the level of somatic health in 1/3 of workers, and to reduce the level of cardiovascular risk in 38% of workers. Conclusion. The therapeutic and prophylactic measures carried out on the seafaring personnel had positive hypotensive, antispastic, antianginal, hemodynamic, lipid-correcting, and adaptogenic effects.

Retrospective Analysis of Experimental and Clinical Studies of the Effect of Sodium Chloride Baths on the Body

AIM. Retrospective analysis of experimental and clinical studies of the effect of sodium chloride baths on the body.&#x0D; MATERIALS AND METHODS. The retrospective analysis included experimental and clinical studies revealing the mechanisms of action of sodium chloride baths on the human body, as well as their therapeutic effect in the rehabilitation of patients with various chronic non-communicable diseases, which were carried out on the basis of the National Medical Research Center for Rehabilitation and Balneology over the past 60 years.&#x0D; RESULTS. It was found that sodium chloride baths (HCV) have a distinctive, inherent effect for them, which depends on the concentration of sodium chloride, the temperature of the water in the bath and the initial state of the body. Experimental work has proved the different effect of HCV of different concentrations on the function of the adrenal cortex. It was found that with an increase in the concentration of sodium chloride in the bath, the observed changes were more pronounced. In the experiment, it was revealed that as a result of the action of HCV, general reactions of the whole organism were observed. Baths with a sodium chloride concentration of 30 g/l change the functional state of the brain in the direction of reducing excitability, and baths with a sodium chloride content of 60 g/l in the direction of its increase. It has been established that HCV is an adequate and pathogenetically justified method of treating patients with CKD. The realization of the therapeutic effect of baths was determined by their anti-inflammatory and desensitizing effect, influence on central and regional hemodynamics. Baths with a sodium chloride concentration of 40 g/l had a more pronounced positive effect. Studies conducted in patients with hypertension have proven the benefits of using HCV with a lower temperature of 31–32 °C. It is also proved that in patients of this category, the use of HCV with a concentration of 40 g/l had a more pronounced hypotensive, antianginal effect and led to an increase in physical performance, to an improvement in central, peripheral and cerebral hemodynamics compared with baths with a concentration of 20 g/l. Other studies testified to the beneficial effect of HCV in coronary heart disease, which was expressed in improving the contractile function of the myocardium and increasing the level of physical performance and coronary reserve of the heart. Analgesic, anti-inflammatory, desensitizing effect of HCV was noted in patients with degenerative-dystrophic and infectious nonspecific joint lesions.&#x0D; CONCLUSION. The presented scientific works of retrospective analysis reveal the mechanisms of the biological and therapeutic effects of HCV. The data obtained are the justification for their use in a number of diseases. For a more successful use of HCV, further regular generalization and analysis of existing evidence-based studies, as well as the implementation of new qualitative randomized controlled clinical trials of the action of HCV, first of all, the determination of the optimal concentration for each nosology, is necessary.

Effectiveness and tolerability of trimetazidine 80mg once daily in patients with chronic coronary syndrome: the V-GOOD observational study

Abstract Background Trimetazidine (TMZ) has shown anti-ischemic and anti-anginal effects by shifting the production of ATP from free fatty acid to glucose oxidation. Few clinical studies have looked at the effectiveness and tolerability of a new presentation of TMZ (80mg once daily) in real-world practice. Purpose The V-GOOD study was conducted in routine clinical practice to evaluate the effect of adding TMZ 80mg OD to treat patients with angina or angina equivalents despite treatment with background anti-anginal therapies. Methods This multicenter, prospective, observational study recruited symptomatic adult outpatients with a confirmed diagnosis of stable angina to whom physicians had decided to prescribe TMZ 80mg OD in 70 health facilities across Brazil from October 2021 to June 2022. Data on the number of angina attacks, the prevalence of angina-free patients, severity of angina (CCS class), impairment in daily activities, treatment adherence, tolerability, and physician and patient satisfaction were collected at baseline (V1) and at 1-month (V2) and 3-month (V3) follow-up visits. Patients with known hypersensitivity to TMZ, Parkinson's disease, related movement disorders, and severe or moderate renal impairment were excluded. Results 1,029 patients (57.9% women) with a mean age of 66.8±10.3 years were included, and 959 (93.2%) completed all three planned visits. Diabetes (53.7%), dyslipidemia (85.1%), and hypertension (85.1%) were the most frequent cardiovascular risk factors; 55.7% of patients had angina CCS class II and 25.1% class III. At V1, the mean number of angina attacks per week was 5.1±3.7 despite anti-anginal therapy, including beta-blockers (82%), CCBs (23%), and nitrates (22%). Following the addition of TMZ 80 OD, it decreased to 3.4±3.3 attacks per week at V2 and 3.5±6.4 at V3 (P&amp;lt;.001). The prevalence of angina-free patients increased from 15.4% (V1) to 73% at V3 (P&amp;lt;.001); accordingly, there was a significant decrease in the proportion of patients with limiting angina (CCS 3 or 4) from 27.3% (V1) to 8.7% (V3) (P&amp;lt;.001). The assessment of impairment in daily activities by a visual scale (ranging from 0 to 10) showed a significant improvement from V1 (5.1±2.2) to V3 (2.1±2.2) (P&amp;lt;.001). Patient adherence to the anti-anginal treatment was excellent, with only 4.4% of patients reporting forgetting to take the drug. The incidence of any adverse event was 2.1% on V3, with 1.1% attributed to the drug. In the end, satisfaction with treatment was classified as satisfactory/very satisfactory by 97.1% of patients and 91.0% of doctors. Conclusion The study confirms that the new formulation of TMZ 80mg OD when added to anti-anginal therapy in patients with symptomatic chronic coronary syndrome effectively reduced the angina frequency and severity, improved functional class, yielded a significant proportion of patients free of angina, decreased physical limitation, and it was well tolerated.

The mechanism and kinetics of antianginal effect formation after laser therapy course in patients with angina pectoris

Purpose: To assess some mechanisms of antianginal effect formation under low-level infrared laser irradiation in patients with angina pectoris, as well as to clarify the kinetics of this clinical effect after laser therapy course. Materials and methods. 88 male patients, aged 54.2 ± 3.7, with angina pectoris of functional class II–III were examined. 63 patients of the main group had a ten-day course of laser therapy. 25 patients were included in the control group in which laser irradiation was only simulated. At the initial stage and one month after laser therapy or its imitation, and in the main group additionally after 3 and 6 months, bicycle ergometric tests were performed to determine exercise tolerance and evaluate the double product indicator at the level of initial (P1) and maximum (P2) threshold load, if its threshold power exceeded the initial one. Results and discussion. The increase of exercise tolerance was observed in 79.5 % of patients from the main group one month later and in 81.7 % three months later after finishing laser therapy course, with the increase in exercise tolerance by 19.1 W (+ 30.4 %; p = 0.023) and by 22.7 W (36.2 %; p = 0.009), respectively. The antianginal effect lasted for about 6 months of follow-up in 62.0 % of treated patients. The double product indicator reflecting myocardial oxygen consumption at P1 level after laser irradiation had a pronounced downward trend. This indicator increased at maximum load (P2) by 19.1 % (p = 0.04) and by 24.1 % (p = 0.006) during repeated examinations in 1 and 3 months, respectively. By the sixth month of observation, studied parameters returned to the initial levels. There were no statistically significant changes in the studied parameters in patients from the control group. Conclusion. The data obtained indicate that a ten-day course of laser therapy triggers high and long-lasting antianginal effect in patients with angina pectoris. The mechanism of its action is caused with the economization factor of cardiac activity and with the increase of coronary blood flow productivity.

The Anti-Anginal Efficacy of Bosentan in the Coronary Slow Flow Phenomenon

Background: The Coronary Slow Flow Phenomenon (CSFP) is a coronary microvascular disorder that presents with recurrent angina for which there is no available effective therapy. The vasoconstrictor Endothelin-1 (ET-1) has been implicated in the pathophysiology of the CSFP. This study aimed to determine whether the ET-1 antagonist (Bosentan) is effective in ameliorating angina symptoms in CSFP patients. Methods: Using a randomised, double-blind, placebo-controlled, cross-over trial methodology, the anti-anginal efficacy of Bosentan 125mg bd was assessed in 23 patients with symptomatic CSFP. Study endpoints were measured following 4 weeks of therapy with the primary endpoint being angina frequency. Secondary endpoints included (1) clinical measures of angina and health status, (2) endothelial function parameters, and (3) inflammatory and oxidative stress markers. Results: There was no statistically significant reduction in angina frequency with Bosentan therapy compared to placebo (median angina episodes/4weeks [25-75% IQ]: Bosentan 14[5,36] vs Placebo 25[9,55]) although a trend for improvement in symptoms during the Bosentan phase was observed. Furthermore, Bosentan did not impact on any of the secondary endpoints compared with placebo. Conclusion: Bosentan did not have a major impact on angina frequency in patients with the CSFP. A small anti-anginal effect cannot be excluded and requires a larger trial.

The Anti-Anginal Efficacy of Bosentan in the Coronary Slow Flow Phenomenon

Background: The Coronary Slow Flow Phenomenon (CSFP) is a coronary microvascular disorder that presents with recurrent angina for which there is no available effective therapy. The vasoconstrictor Endothelin-1 (ET-1) has been implicated in the pathophysiology of the CSFP. This study aimed to determine whether the ET-1 antagonist (Bosentan) is effective in ameliorating angina symptoms in CSFP patients. Methods: Using a randomised, double-blind, placebo-controlled, cross-over trial methodology, the anti-anginal efficacy of Bosentan 125mg bd was assessed in 23 patients with symptomatic CSFP. Study endpoints were measured following 4 weeks of therapy with the primary endpoint being angina frequency. Secondary endpoints included (1) clinical measures of angina and health status, (2) endothelial function parameters, and (3) inflammatory and oxidative stress markers. Results: There was no statistically significant reduction in angina frequency with Bosentan therapy compared to placebo (median angina episodes/4weeks [25-75% IQ]: Bosentan 14[5,36] vs Placebo 25[9,55]) although a trend for improvement in symptoms during the Bosentan phase was observed. Furthermore, Bosentan did not impact on any of the secondary endpoints compared with placebo. Conclusion: Bosentan did not have a major impact on angina frequency in patients with the CSFP. A small anti-anginal effect cannot be excluded and requires a larger trial.

Anti-anginal effects of empagliflozin in patients with type 2 diabetic and refractory angina; A randomized, double-blind placebo-controlled trial (EMPT-angina trial)

Anti-anginal effects of empagliflozin in patients with type 2 diabetic and refractory angina; A randomized, double-blind placebo-controlled trial (EMPT-angina trial)

Сomparative effectiveness of calcium antagonists of prolonged action in patients with stable angina pectoris

The article is devoted to investigation the comparative efficacy of therapy with drugs of calcium antagonists with prolong action — dilren and altiasem PP in old patients, suffering from ischemic heart disease, stable stenocardia 2–3 functional class. There were established more efficacy of therapy with dilren then altiasem PP in the relation to clinical symptoms, hemodynamical parameters and their circadian chronostructure. These data manifested by more essential antianginal, antiischemic and vasodilated effects of dilren then of altiasem PP. There were more essential the increase of tolerance to physical loading, promotion of pumping myocardial function under the influence of dilren and tendency to normalization in circadian organization of hemodynamic parameters.

Features of the management of coronary heart disease in patients with metabolically associated fatty liver disease

Among chronic non-communicable diseases, which make a significant contribution to mortality rates in the developed countries of the world, the leading positions are occupied by diseases of the circulatory system. According to statistics, one million people a year die from cardiovascular diseases in Russia. In an extensive nosological group of diseases of the circulatory system, coronary heart disease is the main cause of death and disability in the adult population. The annual mortality from coronary heart disease among the population of Russia is 27 %. To date, the number of patients with coronary heart disease with comorbid pathology, especially with diseases of the hepatobiliary system, metabolic syndrome, is increasing. The prevalence of metabolically associated fatty liver disease is 20 to 30 % in the population and tends to increase. The combined course of metabolically associated fatty liver disease and coronary heart disease occurs in 14-18 % of cases. Objective: to determine the impact of metabolically associated fatty liver disease on the course of coronary heart disease and the possibility of correcting metabolic disorders to prevent the development of cardiovascular complications. Materials and methods. 35 patients with coronary heart disease and metabolically associated fatty liver disease were examined; they were noted to have more severe clinical course of stenocardia and higher risk of cardiovascular complications, then those patients without liver diseases. Results and its discussion. It was estimated, that using thiotriazoline and ursodeoxycholic acid in addition to standard medicamentous therapy improves clinical course of stenocardia as well as overall quality of life due to high antianginal and antioxidant effects. Conclusions. Hepatoprotective therapy increases possibility of correction of metabolic defects, dyslipidemia, decreases the risk of oxidative stress, prevents development of life threatening cardiovascular conditions and can be used to optimize treatment of comorbid patients.

The effectiveness of cytoprotection in the treatment of stable angina in patients with arterial hypertension and hyperuricemia, taking into account the peculiarities of the course of coronary artery disease in wartime

The aim of the study is to establish the effectiveness of treatment of severe angina pectoris in patients with hyperuricemia, taking into consideration the peculiarities of the course of coronary artery disease (CAD) in wartime, using ranolazine – a selective inhibitor of the late sodium flow in combined pharmacotherapy.&#x0D; Materials and methods. We studied the anti-anginal effect of ranolazine in 14 patients with CAD, stable angina pectoris III-IV functional class (FC), hyperuricemia and arterial hypertension (AH) during 6 months of the 2022 year. The effectiveness of the study drug on the clinical course of angina pectoris was assessed by questionnaire and clinical examination after three months of treatment.&#x0D; The results. At the end of the second week of ranolazine use, angina attacks at rest, which were registered before the start of the observation, stopped in all patients with angina pectoris III FC and 50 % with angina pectoris IV FC. In 78.6 %, the number of angina attacks and the use of nitrates decreased by more than 2 times; 21.4 % no longer had angina attacks.&#x0D; At the end of the first month, anginal attacks were not observed in all patients with angina pectoris III FC and 50 % with angina pectoris FC IV. In 2 patients with angina pectoris IV FC (50 %), anginal attacks continued to be registered during physical exertion and emotional stress, but no more than once a week. At the same time, there were no angina attacks at rest. The same results were obtained during the survey of patients at the end of three months of observation.&#x0D; Conclusions. Ranolazine is an effective component of anti-anginal therapy, significantly affecting the patient's quality of life. Therefore, we can recommend ranolazine for patients with hyperuricemia in angina attacks that persist with insufficient effectiveness of zasic therapy with first-line drugs, especially during military conflicts

Preventive chronotherapy of diltiazem in old patients with ischemic heart disease, stable stenocardia II–III functional classes

BACKGROUND: This study developed a new variant of chronotherapy preventive chronotherapy with a calcium antagonist of prolonged action diltiazem, which is provided before the onset of myocardial ischemia (painful and pain-free) in accordance with ECG monitoring data in older patients with stable angina pectoris.&#x0D; AIM: This study aimed to examine the effectiveness of preventive chronotherapy with diltiazem in older patients with coronary heart disease and stable angina pectoris of IIIII functional classes in comparison with traditional treatment with diltiazem without taking into account the onset of myocardial ischemia during the day.&#x0D; MAATERIALS AND METHODS: The study included two randomized groups of patients with coronary heart disease, i.e., stable angina pectoris. Group 1 included patients (n=15) receiving preventive chronotherapy with diltiazem. Group 2 consisted of patients (n=10) with angina pectoris of 23 functional classes treated with diltiazem by the traditional method. EchoСG was used in the work. ECGHolter monitoring and bimanual physical activity were conducted. The course of treatment was 10 days.&#x0D; RESULTS: The results indicated the advantage of preventive chronotherapy with diltiazem in comparison with traditional treatment. This is confirmed by a more pronounced therapeutic effect in the form of an improvement in myocardial contractile function, decrease in myocardial energy expenditure, increase in exercise tolerance and antianginal, anti-ischemic, and vasodilating effects of diltiazem used in preventive chronotherapy mode (i.e., with an increase in the occurrence time of myocardial ischemia).&#x0D; CONCLUSION: The study data obtained made it possible to establish more pronounced antianginal, anti-ischemic, and hypotensive effects of preventive chronotherapy with diltiazem than these effects of traditional treatment. Moreover, preventive chronotherapy was associated with a greater tolerance to physical activity and a decrease in myocardial energy expenditure.

The place of diltiazem in the treatment of patients with stable angina in concomitant bronchial asthma

Introduction. In the treatment of stable angina in patients with concomitant bronchial asthma (BA), the bronchopulmonary system may be adversely affected by a number of drugs. Diltiazem may be the drug of choice when antianginal therapy with a pulseslowing effect is required, but β-blockers are contraindicated.Aim of the study. To compare the antianginal, pulse-slowing and vasoprotective effects of the calcium antagonist (CA) diltiazem, the calcium antagonist verapamil and the cardioselective beta-adrenoblocker (BAB) bisoprolol in the treatment of stable angina (SA) patients with concomitant BA.Materials and methods. The study included 60 patients with stable angina II-III FC with concomitant mild or moderate persistent BA. The patients were divided into three groups of 20 patients depending on antianginal drugs: Group 1 received betaadrenoblocker bisoprolol, Group 2 – calcium antagonist verapamil, Group 3 – calcium antagonist diltiazem. All patients underwent cardiography (Doppler EchoCG), external respiration function (ERF), endothelium-dependent vasodilation (EDVD) study at baseline and after 2, 4, 6 weeks of treatment.Results. No negative dynamics of FEV1 was found in patients of all groups during the study of ERF after 6 weeks of treatment. There was a statistically significant increase in FEV1 after 6 weeks of treatment in group 3 patients receiving diltiazem (p = 0.032). There was a statistically significant decrease in HR in all three groups during treatment, but in group 2 the dynamics were significantly lower when treated with verapamil. Analysis of mPAP of patients showed that it decreased in all groups after 6 weeks of treatment, but significant dynamics was noted only in Group 3. EDVD test after 6 weeks of treatment revealed positive dynamics, with a statistically significant increase in the index registered in patients of groups 1 and 3.Conclusions. In treatment of patients with stable angina with mild and intermediate persistent disease without exacerbation, antianginal therapy with the calcium antagonist diltiazem has marked antianginal, pulse-slowing action, has vasoprotective effect on the small and large circulatory vessels, improves the parameters of bronchial permeability.

Pleiotropic Effects of Icariside II on the Cardiovascular System: Novel Applications of Ethnopharmacology in Targeting Vascular Remodeling.

Pleiotropic Effects of Icariside II on the Cardiovascular System: Novel Applications of Ethnopharmacology in Targeting Vascular Remodeling.

EFFECTIVENESS AND TOLERABILITY OF BISOPROLOL/PERINDOPRIL SINGLE-PILL COMBINATION IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE AND CONCOMITANT HYPERTENSION WHO HAD A HISTORY OF MIOCARDIAL INFARCTION

Objective: To evaluate effectiveness and tolerability of bisoprolol/perindopril single-pill combination (Bis/Per SPC) in the subgroup with stable coronary artery disease (CAD) and concomitant hypertension (HTN) and a history of myocardial infarction (MI) Design and method: STYLE (NCT03730116) was a 3-month, multicenter, open-label, uncontrolled observational study conducted in Russia. Stable CAD patients (n = 1892) comorbid with HTN and treated with Bis/Per SPC were included from November 2018 to January 2019. Data were collected at 3 visits: V1 (inclusion visit), V2, V3 (1, 3 months). In this post-hoc analysis, the antihypertensive effectiveness of Bis/ Per SPC in the subgroup with a history of MI was assessed by mean change in systolic (SBP) and diastolic blood pressure (DBP) and antianginal effectiveness - by mean changes in number of angina attacks and short acting nitrates (SAN) intake. Treatment tolerability was assessed by investigators as excellent, good, or acceptable. Results: Subanalisis included 495 patients (26.2%) with a history of MI. At baseline (BL), mean age was 62.9 ± 8.5 years, 39.0% (n = 193) were women, mean SBP and DBP were 155.5 ± 16.2 mmHg and 92.1 ± 10.3 mmHg, respectively and mean heart rate (HR) was 80.2 ± 10.3 bpm. By V3, mean SBP/DBP significantly decreased by 29.6 ± 15.2/15.5 ± 10.0 mmHg respectively (p &lt; 0.0001 for both) and 86.9% (n = 430) of patients achieved target BP &lt; 140/90 mmHg. Mean HR decreased by 12.1 ± 8.5 bpm after 1 month and by 16.1 ± 9.6 bpm after 3 months (p &lt; 0.0001 for both) and 27.3% (n = 135) of patients reached target level of HR (55–60 bpm). The proportion of patients who achieved target BP (&lt;140/90 mmHg) with HR &lt; 60 bpm at V3 was 27,5 % (131 of 476). The number of angina attacks per week and intake of SAN decreased from 5.2 ± 14.5 and 5.0 ± 4.9 (at V1) to 0.8 ± 1.7 and 1.3 ± 1.7 (at V3), respectively (p &lt; 0.0001 for both). 97% of investigators rated tolerability of SPC as excellent or good at V3. Conclusions: In stable CAD patients with HTN and a history of MI treated with Bis/Per SPC for 3 months, significant improvement in BP and HR control, reduced angina attacks and SAN intake were observed, and treatment was well tolerated.

Rehabilitation of patients after acute coronary syndrome at the sanatory stage

The article compares the most effective from the point of view of modern scientific views, improved programs of cardio-rehabilitation of patients with acute coronary syndrome after acute myocardial infarction and cardiac surgery at the sanatory stage. The aim of the research: scientific development of improved modern rehabilitation programs for patients with ACS after acute myocardial infarction and/or cardiac surgery (CABG, MAB, coronary artery stenting) at the sanatory stage using a set of non-drug methods that simultaneously restore the metabolism of ischemic myocardium (enhanced external counterpulsation, dry carbon dioxide baths, laser therapy) and the most effective interval training on cyclic simulators and physiotherapy exercises. Material and methods: 100 patients with coronary artery disease after acute coronary syndrome. We compare 3 groups of patients receiving improved interval cyclic exercises on the treadmill and sensory track and therapeutic gymnastics in the gym, or procedures that improve metabolic processes in the myocardium (enhanced external counterpulsation, dry carbon dioxide baths, infrared matrix laser therapy) with a complex of the abovesaid cardio workouts and methods that restore metabolism in ischemic cardiomyocytes and improve adaptation to myocardial ischemia with the development of preconditioning effect, 5 times a week, daily, 8–10 procedures per course. The results of complex rehabilitation in patients of the main group compared with the 2 control groups showed maximum anti-ischemic, antianginal, antiarrhythmic, and antihypoxic effects, due to the simultaneous elimination of metabolic disorders in the ischemic myocardium and the development of cardioprotection, preconditioning. Due to this, the rehabilitation effect of the training itself is significantly increased.