No abstract

The register-based study has shown that the presence of DM2 statistically significantly increases cardiovascular mortality rates during a year after the index ACS event; the patients of this category are less commonly referred for CA for the estimation of the degree of coronary bed lesion. The most important factors of recurrent cardiovascular events in patients with DM2 within a year after prior ACS are multifocal atherosclerosis, reduced myocardial contractility (LVEF less than 51%), and increased vasospastic endothelial function (an increase in ET-1 levels more than 0.87 fmol/ml).

The study included 74patients (22 men and 52 women) aged 48-75yr with type 2 diabetes mellitus (DM2). 62 (88,6%) of them had grade II hypertensive disease (grade II-III by the WHO/ISH-2010 classification), 46 (67%) presented with II- III class functional stable angina of effort, 7 patients survived myocardial infarction, two ones underwent coronary artery stenting. Patients of the main group (n=50) received oral hypoglycemic agents in combination with 1-exenatide (mimetic of glucagon-like peptide) in the form of two daily subcutaneous injections of 5 mcg for 1 month and 10 mcg during the next 5 months. Control patients (n=20) were given standard hypoglycemic therapy. Analysis of highly sensitive CRP demonstrated its increase to 3 mg/l and more in 72.8% of the patients that was responsible for the high risk of cardiovascular disorders. 22,8% of the patients had a CRP level 1,0-2,9 mg/l (moderate risk) and only in 4,2% it was lower than 1 mg/l (low risk). Six months of exenatide therapy resulted in normalization of glycemia, glycated hemoglobin and significant decrease of CRP level which suggested the improvement of the functional state of vascular endothelium due to reduction of chronic inflammation objectively reflected in the highly sensitive CRP level.

Arterial hypertension is the main risk factor for the development of cardiovascular complications and makes a significant contribution to cardiovascular morbidity, including chronic heart failure, and mortality, amounting to more than 45%. The leading risk factors for the development of cardiovascular diseases also include a violation of lipid and carbohydrate metabolism. Current treatments for cardiovascular disease include the administration of angiotensin II receptor blockers. This article provides an overview of the literature data on the efficacy, safety profile of candesartan, high adherence to this drug in patients with arterial hypertension, chronic heart failure, impaired carbohydrate and lipid metabolism. The advantages of candesartan in comparison with other representatives of this group of drugs in the prevention of chronic heart failure are emphasized according to large-scale international randomized trials. Keywords: arterial hypertension, atherosclerosis, diabetes mellitus, insulin resistance, chronic heart failure, candesartan, Hyposart For citation: Evdokimova AG, Stryuk RI, Evdokimov VV, Golikova AA. Reducing the risk of chronic heart failure development in patients with arterial hypertension from the position of evidence medicine (focus on candesartan). Consilium Medicum. 2021; 23 (1): 84–92. DOI: 10.26442/20751753.2021.1.200730

Objective. To study the relationship of gender with the risk factors for coronary artery disease and adverse long-term outcomes in patients with acute coronary syndrome without ST segment elevation (nonST-ACS). Results. Women were older than men, significantly more likely had arterial hypertension and diabetes, but six times less smoked. Coronary artery stenosis >50% in history occurred in men more often than women: 24.2% vs. 11.7%. The median value of the left ventricular ejection fraction in men was significantly lower than in women (56 (49; 63) vs. 60 (50; 64.7), p=0.028). Men were significantly more likely to have a low risk (39.6% versus 24.5%, p=0.0027), and women had a high risk on the GRACE scale (35% versus 21.6%, p=0.0053). Women significantly (p<0.001) were less likely to undergo coronary angiography, while coronary artery stenosis was more frequent (p<0.001) in men than in women. The median scores on the Syntax score were significantly (p<0.001) lower in women - 9.5 (6; 16.5) compared to the same in men - 14 (7; 22). PCI was performed significantly more often in men (p<0.001). Differences in the incidence of adverse cardiovascular events during the five-year follow-up period after discharge after index nonST-ACS for men and women have not been identified. Conclusion. Women with nonST-ACS have more cardiovascular risk factors, in this case, the incidence of adverse cardiovascular events is the same as men with less pronounced coronary lesions, so need to use more actively invasive strategy of women during the index hospitalization.