Efficacy of trimetazidine - an inhibitor of free fatty acids oxidation in the treatment of patients with stable angina pectoris and heart failure.

Aim      To evaluate efficacy of modified-release trimetazidine (TMZ) included into the standard therapy for patients with stable angina and chronic heart failure (CHF) as a part of a subgroup analysis in the PERSPECTIVE study.Material and methods  The study included 806 patients: group 1 (n=691), patients receiving a standard therapy and modified-release TMZ (TMZ group); and group 2 (n=115), patients receiving a standard therapy (control group). Total duration of the study was 12 months.Results In the TMZ group, the weekly number of angina attacks decreased by 41.9% (p<0.0001) in 2 months and by 69.6 % (from baseline, р<0.0001) in 12 months, and the frequency of nitroglycerine dosing decreased by 40.8 % (р<0.0001) and 67.7 % (р<0.0001), respectively. In the control group, the respective values did not change. In the TMZ group compared to the control group, the QT interval was shorter (7.9 %; р<0.05), the left ventricular (LV) end-systolic dimension was reduced (13.4 %; р<0.01), interventricular septal thickness and LV posterior wall thickness were decreased (9.5 %; р<0.01 and 12.2 %; р<0.01, respectively), and the ejection fraction was increased (11.4; р<0.05). Following the TMZ treatment, the leukocyte count in peripheral blood was decreased (5.3 %; р<0.01) and the serum concentration of high-sensitivity C-reactive protein was decreased (30.7 %; р<0.01) vs. increases of these indexes in the control group (17.9 %; р<0.05 and 17.8 %; р<0.05, respectively). The proportion of patients hospitalized for exacerbation of CHF or angina for 12 months was 8.6 % in the TMZ group and 15.7 % in the control group (p=0,001).Conclusion      In patients with stable angina and CHF, inclusion of modified-release TMZ into the standard therapy decreases the number of angina attacks, reduces the activity of inflammatory factors, and improves the course of disease.

[Recommendations of the European Society of Cardiology and the European Atherosclerosis Society on Cardiovascular Disease Prevention and Management of Dyslipidemias. for the Diagnosis of Atherosclerosis and Dyslipidemia Treatment (2016): Basic S.G.]

This review summarizes the main provisions of the new, issued in 2016, recommendations of the European Society of Cardiology and Atherosclerosis Society in cooperation with the European Association on Cardiovascular Prevention and Rehabilitation on Cardiovascular disease prevention and Management of dyslipidemia. In these recommendations, the following trends can be traced distinctly: priority in primary prevention is given to non-drug methods of influence; targets of hypolipidemic therapy are identified not only for low density lipoprotein (LDL) cholesterol (CH), but also for non-high density lipoprotein (HDL) CH, especially in cases of concomitant hypertriglyceridemia. In the field of therapy, in which statins remain the main tool of correction of hyperlipidemia, it is recommended to more widely resort to the use of combination therapy, especially in cases of familial hypercholesterolemia or intolerance to statins; introduction of a new class of drugs- inhibitors of proprotein convertase subtilisin/kexin type 9 makes it possible to further reduce the level of LDLCH, lipoprotein(a) more than 60%. Regarding the wider application of these drugs there are issues related to the relatively limited experience of their use and the lack of data on long-term results and the incidence of side effects. Much attention is paid to more active correction of dyslipidemia in elderly patients, patients with chronic renal failure, diabetes, and several other diseases. The emergence of new European recommendations will undoubtedly serve as a stimulus to the revision of the Russian recommendations, which remain unchanged from 2012.

[The Complex Program of Rehabilitation of Patients With Ischemic Heart Disease After Coronary Artery Bypass Surgery in Ambulatory Cardiorehabilitational Department: Clinical Effects of Third Stage of Rehabilitation].

PURPOSE: to assess clinical efficacy of early post discharge rehabilitation of patients with ischemic heart disease (IHD) after coronary artery bypass grafting (CABG) in conditions of a polyclinical department of cardiological rehabilitation (stage III of cardiorehabilitation). MATERIAL AND METHODS: We included in this study 36 men with IHD in 3-8 weeks (mean 7.8+/-1.6 weeks) after CABG. Patients were randomized in 2groups: patients of the main group attended special "School for patients recovering after CABG" [School] (60-80 min sessions once a week for 5 weeks) and participated in a program of monitored (up to 60 min 3 times a week for 4 months) and unmonitored (home based) exercise training. Patients of the control group attended School and were given advice to do physical exercises at home. Follow up duration was 1 year. RESULTS: Main group. Compared with baseline values after 4 months exercise duration increased 32.6% (p<0.05), this effect persisted at 12 month; threshold exercise load increased 35.2% (p<0.05) after 4, 53.9% after 6, and 49.5% after 12 month. After 4 and 12 months of training some increases of left ventricular (LV) ejection fraction and stroke volume, and decrease of LV end systolic volume occurred. Physical training in this group was associated with improvement of parameters of quality of life. During 12 months of follow up there were no significant changes of concentrations of total and low density lipoprotein cholesterol (TC, LDLC). In the control group slight increase of exercise duration was observed only at 12 months (9.8%, p<0.05), and it was not accompanied by dynamics of exercise tolerance. Increases of concentrations of TC (10.2%, p<0.05) and LDLC (15.6%, p<0.05) were registered at 12 months. Serious cardiovascular complications in the main group (physical training + educational School) were three times less frequent than in the control group (attendance of School only) (11.1 vs. 39.2%, respectively.

[Novel Approaches to Rehabilitation and Secondary Prevention of Survivors of ST-Elevation Myocardial Infarction].

All available data on rehabilitation and secondary prevention after ST elevation acute myocardial infarction (STEAMI) are summarized in corresponding first national recommendations. These recommendations are based on legislative acts concerning medical rehabilitation which have been adopted in Russian Federation during recent years. Recommendations have also taken into account experience of Russian investigators and special national features of development of cardiorehabilitation system as well as possibilities of creation of its material-technical base in this country.

[A home exercise training program after acute coronary syndrome and/or endovascular coronary intervention: efficiency and a patient motivation problem].

AIM: To analyze the impact of a home exercise training (ET) program on quality of life, motor activity (MA), dietary habit, functional and biochemical parameters, and clinical course of the disease in patients who have experienced acute coronary syndrome (ACS) and/or endovascular coronary intervention (ECI). SUBJECTS AND METHOD: The trial included 100 patients after ECL who were randomized into 2 groups: those who had gone through Patient School (PS) and received a 6-week course of controlled ET (a study group (Group S)) and those who had gone through PS only (a control group (Group C). The patients of both groups were recommended a home ET program and, according to its implementation, they formed 2 subgroups: Subgroup A (home ET+) comprising 51 patients who had trained themselves at home) and Subgroup B (home ET-) consisting of 46 patients who had not. The follow-up lasted 1 year. Quality of life, risk factors, lifestyle and clinical parameters were assessed. RESULTS: As time elapsed, the patients' motivation to perform home ET; and, accordingly, the proportion of those who had trained themselves decreased in Group S to 67 and 61% and in Group C to 39 and 40% after 6 and 12 months, respectively. Among the reasons for refusal to perform home ET, disease was reported by only 5.6% of the patients (by all from Group C). The comprehensive physical rehabilitation program (RP) (controlled ET in combination with home ET) produced the best effect in raising the level of daily MA, exercise performance with a 21.3-fold increase in cardiac performance (p < 0.05) and a 14.3-fold decrease in heart rate increment in response to exercises. Group C patients who had refused the home ET program, as compared to those in the same group who had trained themselves at home, showed the worst daily MA levels, none body mass index reduction, and a rise in the low-density lipoprotein cholesterol (by 20.3%; p < 0.05) and in the number of angina attacks (by 1.9 times; p < 0.05). CONCLUSION: RP in the early-stage, which encompasses an educational program (PS), a short-term course of controlled ET and home ET used in patients with ACS, including in those after ECI, has clear clinical benefits. The participation of patients with coronary heart disease (CHD) in the home ET programs increases their motivation and, hence, the proportion of those who participate in therapeutic and rehabilitation measures. Home patient physical rehabilitation is one of the important components of different rehabilitation and prevention programs in patients with CHD after ACS and ECI.

[The use of a short program of physical training in patients with ischemic heart disease after endovascular (coronary) interventions in complex program of rehabilitation and secondary prevention at dispensary-ambulatory stage].

Aim of the study was to assess efficacy of a short program of medium intensity physical training of patients with ischemic heart disease (IHD) after endovascular intervention (EVI) in conditions of practical health care of Russia. Patients (n=100) were randomized into 2 groups - intervention (main group "M", n=50) and control (group "C", n=50) during weeks 2-8 after EVI. Efficacy of undertaken measures was assessed by results of laboratory (lipids), instrumental (electrocardiogram - ECG, exercise test on veloergometer - VEM-test, echocardiography - EchoCG) and clinical investigations. Patients of group M exercised for 45-60 min 3 times/week using work loads 50-60% of those achieved during VEMtest. All patients received therapy standard for EVI treatment IHD as well as lipid lowering drugs when indicated. The use of short program of physical training in this contingent of patients led to significant increase of duration of exercise compared with initial value (by 38% after 1 year, p<0.001) and with control group (p<0.05), increase of efficiency of heart work during VEM-test which differed from that in group "C" at points 1.5 and 6 months (p<0.05). According to EchoCG data parameters of left ventricular (LV) contractility in group "M" significantly improved. With that systolic LV volume diminished 3.1% in 6 months (p<0.05) while its ejection fraction (EF) increased 2.4% (p<0.01). In group "M" at the background of conducted from the very beginning therapy with statins blood concentrations of atherogenic fractions of lipids in blood did not change. At the same time in group "C"their values significantly rose (in 1 year level of total cholesterol - by 12.1%, level of low density lipoprotein cholesterol - by 18.6%, p<0.01 for all comparisons) and at points 4 months and 1 year differences in dynamics of these parameters at intergroup comparison were also significant. In the group of physical training compared with control group according to overall results of 1 year observation more favorable course of disease was registered with more cases of improvement of clinical state (p<0.01) and less cases of its worsening (p<0.01). The obtained results evidence for sufficient efficacy of the short program of physical training and feasibility of its introduction into ambulatory practice for rehabilitation of patients with IHD subjected to EVI on coronary arteries especially in acute coronary syndrome. In combination with the School for IHD patients subjected EVI it can be considered as method of secondary prevention because the study demonstrated its positive effect of risk factors and clinical course of the disease.

[Physical training at ambulatory-polyclinical stage in complex rehabilitation and secondary prevention of patients with ischemic heart disease after acute incidents. Effect on physical working capacity, hemodynamics, blood lipids, clinical course and prognosis (Russian cooperative study)].

AIM: To investigate efficacy of early and long term physical training (PT) of moderate intensity in conditions of practical health care in Russia in patients with ischemic heart disease (IHD) of able to work age - survivors of acute coronary events. MATERIAL AND METHODS: Three hundred ninety two patients were enrolled in this study. They were randomized into intervention group " O" (n=197) and control group " C" (n=195). Inclusion period was 3- 8 weeks from onset of myocardial infarction (MI), unstable angina (UA), or intervention on coronary arteries. Patients were followed up for 1 year and efficacy of intervention was assessed by results of laboratory (levels of lipids), instrumental (ECG, exercise test on veloergometer, echocardiography), and clinical examination. In the group " O" regimen of PT with work loads of moderate intensity (50-60% of power achieved during exercise test) was used. Duration of FT was 45 - 60 min, frequency - 3 times a week. All patients received standard therapy for IHD and a lipid lowering drug when indicated. RESULTS: Proofs of efficacy of PT in the given contingent of patients were obtained. This was manifested by significant increase of physical working capacity: prolongation of exercise time (+31.7%, p<0.001), increases of volume of work performed (+74.3%, p<0.001) and efficiency of cardiac work according to results of exercise tests. All parameters were significantly different from those in the group " C" . Structural functional parameters of the heart also improved in the group " O" : left ventricular (LV) stroke volume increased 4.5% (p<0.005), ejection fraction increased 7.2% (p<0.001), diastolic LV volume decreased 2.5% (p<0.05), systolic LV volume decreased 8.1% (p<0.001). In the group " C" stroke volume and LV ejection fraction rose to a lesser degree - by 5.5% (p<0.01) and 2.9% (p<0.05), respectively. Differences between groups in dynamics of these parameters turned out to be significant (p<0.05). Moreover in group " C" LV diastolic volume increased 2.3% (p<0.05) and systolic volume did not change, while left atrium increased 3.4% (p<0.002). At intergroup comparison differences in dynamics of these parameters were significant (p<0.005). Analysis of lipid profile after 1 year showed no changes in patients of group " C" , while in group " O" it revealed significant (3.6%) lowering of total (T) cholesterol (CH) (p<0.05 compared with baseline and change in group " C" ) and elevation of high density lipoprotein (HDL) CH (+12.3%, p<0.001; compared with group " C" p<0.005). Atherogeneity index TCH/HDLCH decreased 8.5% in the group " O" (p<0.01), and increased 12% (p<0.02) in the group " C" , difference between groups was statistically significant (p<0.001). In the group " O" body mass index decreased 2.8% (p<0.001), and frequency of attacks of angina decreased 50.8% (p<0.001; compared with group " C" p<0.001). Statistically significant differences were registered between the following parameters of composite end point and surrogate points: total number of cardiovascular events - 26 (14.8%) vs 47 (27%), p<0.01; number of cardiovascular catastrophes - 5 (3%) vs 15 (8.7%), p<0.05; number of days out of work because of exacerbation of IHD per 1 person/year - 2.4 vs 4.2, p<0.05 in groups " O" and " C" , respectively. Thus in the group " O" positive effect of PT on the course and outcomes of the disease was registered compared with the group " C" . CONCLUSION: The data obtained are indicative of sufficient efficacy of the used program of PT and feasibility of its application in practice of ambulatory rehabilitation of patients with IHD - survivors of acute coronary events. It also can be looked upon as a method of secondary prevention as results of the study showed its positive impact on risk factors and outcomes of the disease.

[Treatment of patients with arterial hypertension and other stroke risk factors in clinical practice. The PROGNOS program].

AIM: To analyse recent data on the treatment of arterial hypertension (AH) with other risk factors (RF) of cerebral stroke in the Russian Federation, assessment of effects of antihypertensive treatment with a combined drug Hyzaar on the risk of cardiovascular complications (including cerebral stroke), on affection of target organs and metabolic factors of atherosclerosis. MATERIAL AND METHODS: A total of 500 outpatients with primary AH and risk factors including the risk of stroke received Hyzaar (losartan 50/100 mg and hydrochlorthiaside 12.5/25 mg) for one year. RESULTS: More frequent RF in hypertensive patients are the following: high blood cholesterol (86.7%), left ventricular hypertrophy (53.2%), familial history of AH (74.2%). A combination of three and two RF occurs in 49.1 and 37% hypertensive patients, respectively. A 6-month treatment with Hyzaar lowered systolic blood pressure by 28.4 mm Hg and diastolic one by 15.4 mm Hg. The target blood pressure was achieved in 83.5%. Real clinical practice showed that administration of a target Hyzaar dose for 6 months leads to a 6.5% regress of left ventricular hypertrophy, an 11% decrease of total cholesterol, a 4% decrease of glucose and a 8.9% decrease of uric acid. CONCLUSION: A control of AH and correction of RF in hypertensive patients with a high RF of stroke and other cardiovascular complications is real in use of adequate antihypertensive therapy.

[Rehabilitation of patients with ischemic heart disease at outpatient stage.].

The article is assigned to general practitioners and devoted to the outpatient combined rehabilitation of coronary heart disease patients, including those after myocardial infarction. In the part concerning the physical rehabilitation there is given the classification of patients by functional classes, the exercise programs of middle intensity for sport and home training. The formula of selection of the walking training temp according to the results of exercise stress test is given. There are presented the psychodiagnostic methods that evaluate the psychological reactions of patients on the disease, and the methods of psychological rehabilitation with use of psychopharmacotherapy. Special part is devoted to the educational program for patients.

[Exercise in outpatient complex rehabilitation and secondary prophylaxis in patients with ischemic heart disease after acute coronary events (a cooperative trial in Russia)].

AIM: To assess efficacy of early and long-term exercise in patients with ischemic heart disease (IHD) after acute coronary events (acute myocardial infarction--AMI, unstable angina--UA, coronary artery bypass grafting--CABG) in wide outpatient medical practice of Russia. MATERIAL AND METHODS: Three to eight weeks after the acute coronary event (ACE) 373 patients from different clinics of RF regions were randomized into two groups: the study group (n = 188) and a control one (n = 185). Both groups received standard therapy, the study group performed also a special exercise program (moderate exercise for maximum 1 hour 3 times a week for a year). The efficacy of the treatment was assessed by clinical, device and biochemical findings during 6-month follow-up. RESULTS: Physical work capacity, total amount of performed work (PW) in stress test rose in the study group by 26.5% (p < 0.01) and 59.4% (p < 0.01), respectively; HRmax and BPSmax x HRmax increased by 6.4 and 9.8%, respectively, p < 0.01); PW/Hrpeak rose by 48.6% (p < 0.01), PW/DP peak--by 45.9% (p < 0.01). Left ventricular ejection fraction increased by 5.6% (p < 0.05), LV stroke volume--by 3.4% (p < 0.05). In 6 months, controls demonstrated a 4.7% (p < 0.05) rise in HDLP cholesterol, total cholesterol lowered in the study group by 6.4% (p < 0.01), body mass index--by 1.9%, number of anginal attacks--by 0.9%. CONCLUSION: The proposed exercise program is effective and can be applied in outpatients after acute coronary events. The program can be also used as a method of secondary prophylaxis as it lowers total cholesterol, atherogenic index and body mass index.

[Physical activity and atherosclerosis: effect of dynamic activity of various intensity on parameters of lipid-transport system and carbohydrate metabolism in patients with coronary heart disease and type 2 diabetes].

Effect of single bout of dynamic physical exercise on parameters of lipid-transport system and carbohydrate metabolism and hormones (insulin, cortisol) in the blood was studied in patients with coronary heart disease with class I-III angina and type 2 diabetes. Intensity of exercise was limited by severity of stable effort angina and was > 95, 80 and 70% of predicted maximum in patients with class I (n=10), II (n=12) and III (n=14) angina, respectively. High intensity exercise provoked development of atherogenic dyslipidemia: elevation of levels of total cholesterol, low density lipoprotein cholesterol, triglycerides, apolipoprotein B and apolipoprotein B/A1 ratio, and lowering of levels of high density lipoprotein cholesterol and apolipoprotein A1. Patients with diabetes responded to high intensity exercise by elevation of blood glucose and insulin levels and lowering of sensitivity of tissues of the periphery to insulin (glucose/insulin ratio). On the contrary exercise of moderate intensity did not affect negatively metabolism of blood lipids and carbohydrates. Six months course of physical training in patients with diabetes (n=10) corrected exogenous atherogenic dyslipidemia and derangements of carbohydrate metabolism, which developed after acute dynamic effort of high intensity.

[Atorvastatin: lipid lowering activity, pleiotropic properties and efficacy in prevention of atherosclerosis and coronary heart disease]. / Atorvastatin: gipolipidemicheskaia aktivnost', pleiotropnye svoistva i éffektivnost' v profilaktike ateroskleroza i koronarnoi bolezni serdtsa.

The review presents data on pharmacological properties of atorvastatin, its lipid lowering activity, and action on main mechanisms of atherogenesis. Favorable pleiotropic effects of atorvastatin such as normalization of endothelial function, antiinflammatory, antithrombotic and antioxidant activity contribute to stabilization of atheromatous plaques. Clinical trials revealing early and significant effects of the drug on main end points have demonstrated its high value for primary and secondary prevention of atherosclerosis.

[Effect of dietary fat load on the gas exchange parameters and physical work capacity in healthy people and patients with ischemic heart disease]. / Vliianie alimentarnoi zhirovoi nagruzki na pokazateli gazoobmena i fizicheskuiu rabotosposobnost u zdorovykh lits i bolnykh ishemicheskoi bolezníu serdtsa.

The impact of alimentary fat load on physical fitness and gas exchange parameters was studied in 20 healthy individuals and 20 patients with preclinical coronary heart disease (CHD) and 16 patients with manifest CHD. The healthy persons and the patients with preclinical CHD were found to have higher maximum oxygen consumption, increased metabolic units and oxygen pulse during maximum exercises in the presence of fat load, as compared to the values obtained in the exercise test without fat load. In patients with manifest CHD who had alimentary fat load, their physical working capacity decreased: myocardial ischemia developed more rapidly if the test was performed after meal; they also showed lower maximum oxygen consumption, decreased metabolic units and oxygen pulse after fat load tests. The application of spirobicycle ergometry and dietary fat intake enabled a group of persons with patent CHD to be clearly differentiated from that of healthy individuals and patients with evident clinical signs of CHD as compared to the use of spirobycicle without fat load.

[Pravastatin: pharmacological action, pleiotropic effects and efficacy in prevention of atherosclerosis]. / Pravastatin: osobennosti farmakologicheskogo deistviia, pleotropnye éffekty i éffektivnost' v profilaktike ateroskleroza.

This literature review presents data on pharmacological action of pravastatin, its lipid lowering activity, and influence on main mechanisms of atherogenesis. Beneficial pleiotropic (nonlipid) effects of pravastatin: normalization of endothelial function, antiinflammatory action, antiischemic- and antithrombotic effects are also described. These effects represent possible mechanisms of participation of pravastatin in stabilization of prone to rupture atheromatous plaques. Early and pronounced clinical efficacy of pravastatin demonstrated in trials with clinical endpoints is discussed and value of the drug for primary and secondary prevention of atherosclerosis stressed.

[Impact of exercise on alimentary hyperlipoproteinemia in patients with ischemic heart disease]. / Vliianie fizicheskikh nagruzok na alimentarnyiu giperlipoproteidemiiu u bolnykh ishemicheskoi bolezníu serdtsa.

The impact of graded exercises of various intensity and duration on serum lipoprotein values was examined in 20 patients with coronary heart disease (CHD) and 10 healthy individuals after a single dietary fat load (FL). FL resulted in hypertriglyceridemia which was accompanied by elevated apo-AI levels and reduced apo-B/apo-AI ratio in the healthy persons, whereas it was accompanied by lower apo-AI levels and increased apo-B/apo-AI ratio in the patients. The short-term maximum exercise in the presence of FL caused negative shifts in the lipid transport system both in the healthy persons and the patients, by elevating the level of apo-B-containing lipoproteins. Yet, the healthy individuals showed a further increase in apo-AI concentrations. The long-term exercise in the training mode corrected changes in lipid values, which had been induced by FL in the two groups of the examinees. There was a decrease in the levels of triglycerides, low density lipoprotein, cholesterol and an increase in the level of high density lipoprotein cholesterol.

[Syndrome of impaired tolerance to dietary fats in coronary heart disease]. / Sindrom narushennoi tolerantnosti k pishchevym zhiram pri koronarnoi bolezni serdtsa.

Changes of main lipid and apolipoprotein parameters of lipid transport system during postprandial hyperlipidemia were studied in subjects without (n=72) and with (n=167) overt coronary heart disease (CHD) including patients with noninsulin dependent diabetes (n=48). Tolerance to dietary fat was evaluated by oral fat load test (consumption of 639+/-7 ml of 20% cream after fast). In subjects without CHD reaction of lipid transport system to fat load was characterized by lowered total, low density lipoprotein cholesterol, apolipoprotein apo B and apo B/apo A-1 ratio, lowered or unchanged triglycerides, stable high density lipoprotein cholesterol level at the background of apo A-1 elevation by 6-th hour after load. Patients with CHD exhibited signs of impaired tolerance to dietary fat: elevation of triglycerides, apo B and apo B/apo A-1 ratio, lowering of high density lipoprotein cholesterol, increase of percentage of subfractions of small high density lipoproteins particles, increase of triglyceride content in low and high density lipoprotein fraction during 6 hours after fat load.

[Physical exercise and atherosclerosis: proatherogenic effects of high and moderate intensity static exercise on blood lipid transport system]. / Fizicheskie nagruzki i ateroskleroz: proaterogennoe vliianie staticheskikh nagruzok vysokoi i umerennoi intensivnosti na lipidtransportnuiu sistemu krovi.

Effects of high (100 and 80 kg) and moderate (60 kg) intensity static leg exercise on blood serum lipoproteins and apolipoproteins (apo) A1 and B were studied in healthy subjects (n=11) and patients with coronary heart disease and class I angina (n=11). Static leg exercise with loads exceeding 60 kg were associated with atherogenic changes of blood lipid transport system: elevation of levels of triglycerides, apoprotein B and apo B/A ratio both in healthy subjects and patients, and of total and low density lipoprotein cholesterol in patients. These post exercise changes were more pronounced in the presence of fasting hyperlipidemia and their severity increased with increase in duration of exercise. Static leg exercise did not increase concentration of high density lipoprotein cholesterol. For prevention of post exercise atherogenic dyslipidemia it is expedient to supplement strength training programs with dynamic exercise of moderate intensity.

[Correction of atherogenic exogenously-induced postprandial hyperlipidemia with pravastatin]. / Pravastatin v korrektsii aterogennoi ékzogenno-indutsirovannoi postprandial'noi giperlipidemii.

Effect of an HMG-CoA reductase inhibitor pravastatin on atherogenic changes in the lipid transport system during postprandial hyperlipidemia immediately after ingestion of fatty meal was studied in patients with coronary heart disease and fasting hyperlipidemia. Treatment with pravastatin (20-40 mg/day for 3 months) resulted in normalization of fasting levels of blood lipids and decreased postprandial hyperlipidemia due to of enhanced removal of triglyceride-rich atherogenic lipoproteins from blood and their diminished secretion in response to fat load. Moreover pravastatin increased tolerance of the lipid-transport system to exogenous saturated fats. KEY WORDS. coronary heart disease; postprandial hyperlipidemia; pravastatin; lipoproteins, metabolism.

[Efficacy and safety of simvastatin in patients with hypercholesterolemia (results of a Multicenter Clinical Study)]. / Effektivnost' i bezopasnost' simvastatina u patsientov s giperkholesterinemiei (rezul'taty mnogotsentrovogo klinicheskogo issledovaniia).

AIM: To assess efficacy and safety of a generic preparation of simvastatin Vasilip (KRKA) in ischemic heart disease patients with hypercholesterolemia or combined hyperlipidemia. MATERIAL: Patients (n=167, age 36-73 years) with ischemic heart disease and moderate hypercholesterolemia or combined hyperlipidemia. METHODS: Duration of simvastatin administration was 12 weeks. All patients received 20 mg/day for 6 weeks. Then those patients who did not achieve target low density lipoprotein (LDL) cholesterol level (3.0 mmol/l) were given 40 mg/day for 6 more weeks. Other patients continued to take 20 mg/day. RESULTS: The use of Vasilip was associated with lowering of total, LDL cholesterol and triglycerides (by 28, 39 and 10%, respectively) and 18% elevation of high density lipoprotein cholesterol. Target LDL CH level was achieved in 107 patients (66.9%). In 47 patients (29.4%) LDL CH concentration remained higher than target level but decrease of LDL CH exceeded 10%. Six patients (3.8%) did not respond to therapy. Treatment was stopped because of adverse effects in 2.4% of patients. CONCLUSION: A generic preparation of simvastatin Vasilip in a 12-week open noncomparative study demonstrated substantial lipid lowering activity and did not induce serious adverse reactions.

[Physical exercise and atherosclerosis: dynamic high intensity exercise as a factor inducing exogenous dyslipidemia]. / Fizicheskie nagruzki i ateroskleroz: dinamicheskie fizicheskie nagruzki vysokoi intensivnosti kak faktor, indutsiruiushchii ékzogennuiu dislipidemiiu.

Effect of dynamic exercise of various intensity (maximal 100% and submaximal -- 80, 70 and 60% of individual maximally tolerated work load) on blood lipids, lipo- and apolipoproteins (apo) was studied in healthy subjects and patients with coronary heart disease. Both in healthy persons and patients high intensity (100 and 80%) exercise was associated with atherogenic changes of lipid transport system: increases of levels of total and low density lipoprotein cholesterol, triglycerides, apolipoprotein B and apo B/apo-A1 ratio. On the contrary, changes after exercise of moderate (60%) intensity (lowering of apo-B containing lipoproteins in healthy subjects and patients and elevation of apo-A1 concentration in healthy subjects) were antiatherogenic.