Osteoarthritis (OA) is the leading musculoskeletal cause of disability. Despite this, there is no consensus on the precise definition of OA and what is the best treatment to improve symptoms and slow disease progression. Current pharmacological treatments include analgesics, non-steroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase (COX) inhibitors. None of those treatments are disease-modifying agents that target the core pathological processes in OA. Diacerein, a semi-synthetic anthraquinone derivative, inhibits the interleukin-1-beta (IL-1β) cytokine which, according to animal studies, plays a key role in the pathogenesis of OA. Diacerein was synthesized in 1980 and licensed in some European Union and Asian countries for up to 20 years. It has shown modest efficacy and acceptable tolerability in a number of trials of low to moderate quality. Early this year, the European Medicines Agency (EMA) conducted a review and restricted the use of diacerein-containing medicines. This was because of major concerns about the frequency and severity of diarrhoea and liver disorders in OA patients. In addition, the EMA's Pharmacovigilance Risk Assessment Committee (PRAC) questioned the limited clinical benefits of diacerein, which, in their view, did not outweigh its risks. The aim of this review is to provide a benefit-risk assessment of diacerein in the treatment of OA, based on asystematic evaluation of the published efficacy and safety data. Overall, there is evidence that diacerein is modestly effective for symptoms and possibly for radiographic changes, but this needs to be balanced against higher rates of gastrointestinal toxicity.

We performed a literature search using the terms RA, safety and long term. Papers identified by this search were screened for relevance and then included in this narrative review. Efficacy One cannot use long-term open-label studies to determine efficacy for a number of reasons. These

Background In contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity. Methods and results CLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia, and Africa in 2009–2010, and followed up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischaemia, or prior revascularization procedure. Among 32 694 patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to ∼60% in the Gulf countries. In a multivariable-adjusted Cox proportional hazards model, diabetes was associated with increased risks for the primary outcome (cardiovascular death, myocardial infarction, or stroke) with an adjusted hazard ratio of 1.28 (95% confidence interval 1.18, 1.39) and for all secondary outcomes (all-cause and cardiovascular mortality, myocardial infarction, stroke, heart failure, and coronary revascularization). Differences on outcomes according to geography and ethnicity were modest. Conclusion In patients with chronic coronary syndromes, diabetes is independently associated with mortality and cardiovascular events, including heart failure, which is not accounted by demographics, prior medical history, left ventricular ejection fraction, or use of secondary prevention medication. This is observed across multiple geographic regions and ethnicities, despite marked disparities in the prevalence of diabetes. ClinicalTrials identifier ISRCTN43070564

Aim. To study features of heart rate of men with arterial hypertension and obesity, to identify factors associated with arrhythmia evolution.Materials and methods. The study included 3 groups of men (with obesity – 98 men, with excessive body weight – 46 men, with normal body weight – 40 men). The comparative analysis of heart rhythm was performed with Resting ECG and Holter ECG monitoring, blood pressure from daily monitoring, echocardiography, blood lipid spectrum, glycaemia. The adiponectin level was analyzed only for group with obesity.Results. Obesity in men with arterial hypertension increases the frequency of arrhythmias of atrial fibrillation (AF) type (15.3% vs. 0% in group with normal body weight, p=0.004) and increases the frequency of ventricular premature beats (VPB) (26.5% in group with obesity vs. 10% in group with normal body weight). We were also able to show the relation between arrhythmia and the severity of obesity. Obesity with arterial hypertension significantly increases the risk of various arrhythmias (more than 6 times for AF risk – p=0.004 and more than 5.31 times for frequent VPB – p=0.026. Risk factors for AF are statistically significant with the presence of obesity: left ventricular (LV) and left atrium (LA) dilation, II–III stage of hypertension and low level of high-density lipoprotein (p0.05). AF risk factors are significant without relation to obesity: left ventricular hypertrophy, dilatation LA, IHD (p0.05). But there is no relation between ischemic heart disease (IHD) and an increased risk of AF evolution. Also no relation was found between sleep apnea syndrome and arrhythmias.Conclusion. Men with excessive body weight or obesity in contrast to men with normal body weight have an increased risk of AF and VPB. Factors directly associated with arrhythmias: heart remodeling (hypertrophy and dilatation of the left ventricular, dilatation of the left atrium), advanced stages of arterial hypertension, dyslipidemia; IHD with obesity associated with risk of VPB and doesn’t affect the AF frequency.

Россия, 603000, Нижний Новгород, ул. Малая Покровская, 12, тел. +7-903-606-24-86, e-mail: gospital.mschmvd.52@gmail.ru Реферат. Цель исследования -выявить распространенность риска развития синдрома обструктивного апноэ сна у пациентов трудоспособного возраста с артериальной гипертонией, имеющих нормальную, из-быточную массу тела и ожирение, а также проанализировать взаимосвязь риска синдрома обструктивного апноэ сна с некоторыми антропометрическими и лабораторно-инструментальными показателями. Материал и методы. В исследовании приняли участие мужчины трудоспособного возраста с артериальной гипертонией и нормальной массой тела или ожирением. У всех пациентов оценивалась вероятность развития синдрома обструктивного апноэ сна по опроснику Центра медицины сна ФГБУ «Санаторий Барвиха». На основании тестирования обследованные были разделены на группы с низким, умеренным и высоким риском. Кроме того, проводился анализ липидограммы, суточное ЭКГ-мониторирование, эхокардиография по стандартно-му протоколу. Результаты и их обсуждение. Высокий риск развития синдрома обструктивного апноэ сна при артериальной гипертензии был связан с большим возрастом пациентов, наличием степени ожирения, признаками метаболического синдрома, гиперхолестеринемией, гипертриглицеридемией, высоким коэф-фициентом атерогенности. Морфофункциональные показатели миокарда в данной группе обследованных отличались склонностью к тахикардии, экстрасистолии, развитием диастолической дисфункции левого же-лудочка, формированием гипертрофии межжелудочковой перегородки и дилатации левого предсердия. Учет этих особенностей позволяет определить прогноз у больных данной категории. Выводы. Высокому риску развития синдрома обструктивного апноэ сна подвержены пациенты с избыточным весом, ожирением и метаболическим синдромом. Среди лабораторно-инструментальных показателей в группе с высоким риском развития синдрома обструктивного апноэ сна наибольшую значимость имеют атерогенная гиперлипидемия, склонность к аритмии, диастолическая дисфункция левого желудочка, развитие ремоделирования миокарда левого желудочка, дилатация левого предсердия. Ключевые слова: синдром обструктивного апноэ сна, ожирение, артериальная гипертензия. Для ссылки: Риск развития и неблагоприятные кардиоваскулярные эффекты синдрома обструктивного апноэ сна у пациентов трудоспособного возраста с артериальной гипертензией, имеющих нормальный и избыточный вес / О.В. Каратаева, Е.И. Панова, Е.П. Морозова [и др.] // Вестник современной клинической медицины. -