The article reports the modern tactics of treating patients with chronic heart failure and concomitant anemia. The results of the most important randomized clinical trials that are the basis for developing approaches to the treatment of anemia in such cases are discussed. Attention is also paid to unresolved problems in the treatment of anemia in patients with heart failure. The data on the intravenous administration of iron preparations as the most effective approach to the treatment of anemia in patients with heart failure in the presence of iron defciency are given. The main provisions of modern clinical guidelines on the management of patients with heart failure and anemia are considered.
The article discusses the vascular age concept and modern approaches to assessing vascular age. It describes modern methods for measuring arterial stiffness (applanation tonometry or ultrasonic Doppler examination) as the most frequently used index of vascular age. The authors discuss the role of antihypertensive therapy and statins in preventing early vascular aging, and the relationship between the role of achieving lower blood pressure levels and the choice of certain antihypertensive agents to reduce arterial stiffness and ensure optimal vascular age. Increased arterial stiffness has been reported to be a marker of risk for developing severe complications of cardiovascular diseases, in particular, a meta-analysis showed that after taking into account the known risk factors for developing cardiovascular complications, higher carotid stiffness was associated with an increased risk of stroke. It is stated that in addition to biological age, vascular age may increase due to the cumulative effect of such risk factors as high blood pressure, impaired glucose homeostasis, obesity and hypercholesterolemia. Modern approaches to the preservation and maintenance of vascular age are discussed. The key role of achieving lower blood pressure levels is considered. It is emphasized that the role of combination drugs in preventing complications of cardiovascular diseases is strengthened, and approaches to choosing the optimal components of such combination drugs are also considered. The relationship between increased arterial stiffness and the development of cognitive disorders is discussed. The article describes the role of statins and effectiveness of the concomitant use of statins and combination antihypertensive therapy in reducing the pulse wave velocity.
В статье рассматриваются современные представления о роли механической реваскуляризации миокарда и лекарственной противоишемической терапии в лечении больных со стабильным течением ишемической болезни сердца (ИБС). Приводятся современные данные о сравнительной эффективности противоишемических препаратов, которые стали основанием для разработки концепции "бриллиантового подхода" к лечению больных со стабильным течением ИБС, которая предлагается вместо стандартной тактики с использованием иерархического подхода к выбору противоишемических средств. Рассматриваются особенности применения противоишемических препаратов в определенных клинических ситуациях, у больных с наиболее распространенными сопутствующими заболеваниями или осложнениями ИБС, а также при вариантах ИБС, в развитии которых играют роль специфические патофизиологические звенья. Ключевые слова: ишемическая болезнь сердца, тактика лечения, механическая реваскуляризация. Конфликт интересов: не заявлен.
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