[Efficacy and safety of levilimab in the treatment of patients with rheumatoid arthritis].

AIM: Evaluation in real clinical practice of the effectiveness and safety of levilimab therapy in patients with highly and moderately active rheumatoid arthritis (RA). MATERIALS AND METHODS: A prospective observational study (6 months) involving 35 patients with RA (29 women and 6 men, mean age 53.17±13.2 years) who were treated at the Ochapovsky Regional Clinic Hospital of Krasnodar Region. All patients included in the study were prescribed the drug levilimab (Ilsira). RESULTS: After 1 month of observation, there was a decrease in the clinical and laboratory activity of the process in the form of a decrease in the number of painful joints - 17.0 (14.0; 20.0) vs 8.0 (6.0; 10.0); p=0.000001, number of swollen joints - 3.0 (2.0; 4.0) vs 0.0 (0.0; 0.0); p=0.000002, reduction in pain intensity according to visual analog scale - 60.0 (60.0; 70.0) mm vs 30.0 (20.0; 40.0) mm (p=0.000001). Also, by the end of the first month of therapy, there was a decrease in clinical activity indices DAS28-ESR by 43%, SDAI by 60%, CDAI by 55%. Positive dynamics of laboratory parameters were noted - a decrease in erythrocyte sedimentation rate by 76%, a decrease in C-reactive protein level by 98%. By the 6th month of therapy, a decrease in RF by 36% and ACCP by 11% was recorded, but the dynamics of these indicators did not reach statistical significance. By the end of 4 weeks of treatment, 24 (68.6%) patients showed an increase in the level of total blood cholesterol - 5.1 (3.91; 6.0) mmol/L vs 6.1 (4.99; 7.07) mmol/L (p=0.000006), while 11 (45.8%) patients from this group had initially elevated cholesterol levels (6.4±0.6 mmol/L). In 5 (14.3%) patients, an increase in alanine aminotransferase (ALT) was recorded in the 4th week - 17.0 (11.0; 25.0) U/L vs 32.0 (22.0; 43.0) U/L (p=0.000062) and aspartate aminotransferase (AST) - 19.0 (14.0; 24.0) U/L vs 25.0 (18.0; 36.0) U/L (p=0.000171), in 1 (2.85%) of the patient, an increase in ALT and AST above normal was noted (ALT 144 U/L, AST 52 U/L), which required discontinuation of levilimab. In 2 (5.7%) patients, by the end of the 4th week a decrease in the absolute number of neutrophils was registered - 3.2 (2.6; 4.0)×10E9/L vs 2.3 (2.0; 2.5)×10E9/L (p=0.002), which did not require discontinuation of treatment, since the number of cells remained more than 1×10E9/L. During treatment with levilimab 162 mg subcutaneously once a week, the proportion of patients taking prednisolone decreased from 46% at the start of therapy to 11% at the end of 6 months of therapy. CONCLUSION: Levilimab is a highly effective drug for the treatment of patients with highly and moderately active RA and has a favorable tolerability and safety profile.

[Experience of using a triple fixed combination in the treatment of patients with chronic obstructive pulmonary disease].

AIM: To evaluate the effectiveness of a fixed triple combination of vilanterol/umeclidinium bromide/fluticasone furoate in the treatment of chronic obstructive pulmonary disease (COPD) patients with frequent exacerbations. MATERIALS AND METHODS: The study included 46 patients with severe and extremely severe COPD (GOLD 34) with frequent exacerbations. All patients were divided into 2 groups. The 1st group included 22 COPD patients with a content of eosinophils in the peripheral blood of 300 cells/ml, the 2nd group included 24 COPD patients with no signs of eosinophilic inflammation in the peripheral blood. Group 1 patients were recommended therapy with a fixed triple combination of vilanterol/umeclidinium bromide/fluticasone furoate at a dose of 22/55/92 mcg 1 time per day, group 2 patients received vilanterol+umeclidinium bromide at a dose of 22/55 mcg 1 time per day. The duration of follow-up was 12 months. RESULTS: After 12 months of treatment with a fixed triple combination of vilanterol/umeclidinium bromide/fluticasone furoate, a statistically significant decrease in peripheral blood eosinophilia was noted in patients with COPD with frequent exacerbations and peripheral blood eosinophilia (p=0.001), as well as a decrease in shortness of breath on the MMRs scale (p=0.001) and the frequency of exacerbations in patients with COPD with frequent exacerbations and eosinophilia (p=0.001). CONCLUSION: The use of a fixed combination of vilanterol/umeclidinium bromide/fluticasone furoate for 12 months allowed to reduce the impact of the disease, improve respiratory function and quality of life in COPD patients with eosinophilia.

[Analysis of the dynamics of mortality from respiratory diseases in the Russian Federation for 2019-2020].

AIM: To study the dynamics and contribution of mortality from Diseases of the respiratory system (DRS) in 2019 and 2020 to mortality from all causes with and without deaths from COVID-19 in 82 regions of the Russian Federation. MATERIALS AND METHODS: The data provided by Rosstat for 2019 and 2020 on the average annual population and the number of deaths due to causes of DRS (class J00J99) were used the standardised death rate (SDR) were calculated, the regional average value, standard deviation and coefficient of variation. RESULTS: The average increase in the SDR from DRS in 2020 was 22.1913.22 per 100 thousand population (66.4489.6% higher than in 2019). The average regional SDR from DRS + COVID-19 in 2020 was higher than the SDR from DRS in 2019 by 87.6530.1 per 100 thousand population. The average regional share of SDR in the structure of mortality excluding COVID-19 increased from 3.661.44 to 5.062.49%; taking into account COVID-19, it increased to 10.963.13%. In 16 regions, the SDR from DRS + COVID-19 exceeded the increase in mortality from all causes. No correlation was found between SDR (2020) from all causes and SDR from COVID-19 (r=0.09; p=0.39); an inverse correlation was found between SDR from DRS and SDR from COVID-19 in 2020 (r=-0.42; p0.0001). CONCLUSION: Against the background of high interregional variability of SDR from DRS in most regions, an increase in the mortality rate from DRS and the contribution of DRS to total mortality in 2020 was registered.

[Frequency of albuminuria in patients with bronchial obstructive diseases.]

The aim of the study was to study the frequency and features of albuminuria in patients with chronic bronchoobstructive lung diseases. The prospective study involved 219 patients with COPD (GOLD 1-4) and 201 patients with persistent bronchial asthma (BA) of varying severity, who were examined in 2018-2019. The control group consisted of 48 volunteers, comparable in age and gender. In addition to General clinical studies, all patients were calculated BMI and visceral obesity detection based on the waist-hip ratio (WHR), and the Smoking index (HCI) was calculated. Albuminuria was determined based on the calculation of the albumin / creatinine ratio in a single morning portion of urine. The frequency of optimal / slightly elevated AU (A1) was 28,7% (63) among COPD patients and 9% (18) of BA patients. The number of COPD patients with clinically significant AU (A2, A3) was 24,2% (53) of patients, which is statistically significantly higher than among BA patients (5,5% of patients; χ2=22,3, p=0,01). The factors that make a statistically significant contribution to the development of AU in patients with COPD were the frequency of exacerbations over the previous 12 months, ICP, fibrinogen and CRP levels, FEV1; in BA patients - WHR, ICP. Smoking contributes to the development and potentiation of renal dysfunction in patients with bronchial obstructive diseases. The issue of considering BA as a risk factor for renal dysfunction remains controversial, given the diversity of BA both in terms of disease phenotypes, severity, and variety of therapeutic approaches.

[The role of occupational factors in the development and course of respiratory sarcoidosis].

AIM: The aim of the study was to study the frequency of occurrence of exposure to harmful occupational factors in patients with sarcoidosis of the respiratory organs, depending on the course of the disease. MATERIALS AND METHODS: An open prospective study included 121 patients with sarcoidosis of the respiratory system from the age of 21 to 66 years, from 20072019. The diagnosis was histologically confirmed in all patients. Patients underwent a set of laboratory and instrumental examinations, studied profane history. The presence of a history of contact with harmful and dangerous production factors was clarified. To determine the effect of a harmful production factor on the course of sarcoidosis, patients were divided into 2 clinical groups: the first group consisted of 85 (70.2%) patients with a favorable course of the disease, the second group included 36 (29.8%) patients with an unfavorable course sarcoidosis (standardization coefficient between groups 2.4:1). RESULTS AND DISCUSSION: Among the examined patients of working age prevailed (87%). Patient groups were comparable by age, but statistically differed by gender (chi2=9.75, p=0.0018). Frequency analysis of the occurrence of harmful occupational factors in sarcoidosis of the respiratory organs showed that the most frequently encountered factors in all the studied groups were contact with chemical hazards. CONCLUSION: The presence of contact with harmful production factors increases the risk of an unfavorable course of sarcoidosis by more than 2 times.

[The influence of treatment with inactive vitamin D on intrarenal blood flow in patients with chronic obstructive pulmonary disease.]

The aim of the work was to assess the dynamics of ultrasound parameters of renal blood flow in patients with chronic obstructive pulmonary disease (COPD)and initial stages of chronic kidney disease (CKD) during treatment with inactive vitamin D. The study included 264 patients with COPD of 2-4 degrees of severity in combination with CKD of 1-2 stages: 135 patients of the main group and 129 patients of the control group. Each group was divided into 4 subgroups according to the value of FEV1 and vitamin D level. In the main group, the native vitamin D was prescribed according to the scheme providing maintenance of vitamin D level >34,3 ng/ml during the year, in the control group - according to the recommendations of the Russian Association of Endocrinologists. An ultrasound of the kidneys with the calculation of the resistance index (RI) and albuminuria level were carried out in all patients at inclusion into the study and after its completion. A decrease in the severity of albuminuria from A3 to A2 was revealed in 24,1% (16), and an increase in GFR - in 42,9% (58) patients of all patients in the main group. A statistically significant decrease in the renal artery resistance index was recorded in the group of patients with moderate COPD (GOLD 2) and vitamin D deficiency in the main group (p<0,05). The maintaining of vitamin D levels more than 34,3 ng/ml over 12 months in patients with COPD in combination with CKD stage 1-2 was associated with a decrease in the severity of albuminuria, with an increase in GFR, and statistically significant decrease of resistance index in renal arteries of patients with moderate clinical course of COPD (GOLD 2) and lack of vitamin D.

[The factors associated with vitamin D levels in patients with chronic obstructive pulmonary disease in combination with renal dysfunction.]

The goal of study was to find factors associated with vitamin D levels in patients with chronic obstructive pulmonary disease (COPD) and early stages of kidney dysfunction. The study included 338 patients with 1-2 COPD stages (66,9% of men, mean age was 69,4±6,1 years, mean COPD duration was 18,5±4,1 years); 33,1% of women (mean age 64,8±7,3 years, mean COPD duration was 12,1±5,1 years). All patients were diagnosed with 1-2 stages of chronic kidney disease (CKD). In addition to general clinical examination, potential risk factors for vitamin D deficiency were assessed. During multiple regression with step-by-step inclusion method the following factors showed a significant contribution to the formation of vitamin D levels in patients with COPD and early stages of renal dysfunction: the frequency of exacerbations of COPD in the preceding 12 months (3 (2-4), ß=0,932, p=0,003), SI (44 (15-87), ß=0,038, p=0,006), fibrinogen level (5 (3-7), ß=0,413, p=0,016), GFR (74,9 (68,4-89), ß=0,119, p=0,041), insolation (94,5 (38,5-152), ß=0,026, p=0,0008),the total score on a GDS scale (9 (8-11), ß=0,536, p=0,014). R2 for this model was 0,87. BMI made a significant contribution to the formation of vitamin D level at the step of inclusion to the multivariate analysis, but when included in the analysis of insolation markers, the relationship weakened and completely disappeared when the values of SI were included. FEV1 values do not affect on vitamin D level in COPD patients in combination with early stages of kidney dysfunction.

[Predictors for development of major cardiovascular events in elderly patients with severe and extremely severe chronic obstructive pulmonary disease in combination with early stages of chronic kidney disease].

AIM: To study the structure of major cardiovascular events (MCVE) and to identify their independent predictors in elderly patients with severe and extremely severe chronic obstructive pulmonary disease (COPD) in combination with early stages of chronic kidney disease (CKD). MATERIALS AND METHODS: The study included 172 elderly patients with stage 3-4 COPD associated with stage 1-2 CKD. Initially, risk factors for MCVE were identified and levels of vitamin D (25 (ОН) D) were measured for all patients. In 12 months, MCVE anamnesis was collected, and patients were divided into two groups with and without MCVE during the observation period. The risk factors for MCVE, which were significantly different between the two groups according to results of a one-way analysis, were successively included into a logistic regression for identifying independent predictors of MCVE. A ROC analysis was performed for the identified variables to identify a predictive cut-off point. RESULTS: 21 MCVEs were observed in 8.7% (15) patients. Heart rhythm disorders (HRD) not reversed at the prehospital stage were observed in 38.1% patients; acute cerebrovascular disease and transient ischemic attack - in 23.8%, acute coronary syndrome - in 23.8%, and pulmonary thromboembolism (PTE) - in 14.3%. Two MCVEs, namely, a combination of HRD not reversed at the prehospital stage and PTE, were observed in 3 (20%) patients. The ROC analysis showed that the incidence of COPD exacerbation for the previous 12 months >3 had the highest predictive value for the 12-month risk of MCVE in patients with COPD associated with early CKD (95% CI, 0.823-0.925, р=0.001). A total PROCAM score <50 (95% CI, 0.882-0.964, р=0.001); GFR ≥80 ml/min/1.73 m2 (95% CI, 0.750-0.870, р=0.001); and a level of vitamin D ≥33 ng/ml (95% CI, 0.730-0.855, р=0.001) reduced the risk for MCVE. CONCLUSIONS: In elderly patients with grade 3-4 COPD associated with stage 1-2 CKD, the development of MCVE within 12 months was determined by the incidence of COPD exacerbations for the previous 12 months >3 while a total PROCAM score <50, GFR >80 ml/min/1.73 m3 , and levels of vitamin D >33 ng/ml reduced the risk of MCVE in these patients.

[Factors associated with a reduction in glomerular filtration rate in patients with chronic obstructive pulmonary disease].

AIM: Analysis of factors associated with reduced glomerular filtration rate (GFR) in patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: The study included 198 patients with COPD 1-4 degrees of severity (GOLD 2014), who were on examination and treatment in Krasnodar Regional clinical hospital № 2. The control group consisted of 28 healthy volunteers, comparable in age and sex. In addition to clinical research, all patients, we calculated GFR according to the formula CKD-EPI based on cystatin C serum (GFRcys). The contribution of the factors in the risk of developing CKD was determined using multivariate linear regression analysis, as dependent variable used the value of GFRcys. RESULTS AND DISCUSSION: It was found that more than half (51.5%) of patients with COPD have a decrease in GFRcys.

[The relationship of vitamin D level with markers of cardiorenal syndrome in patients with chronic obstructive pulmonary disease.]

The aim of the study was to examine the relationship of vitamin D levels with markers of cardiorenal syndrome in patients with COPD depending on the severity of bronchial obstruction.198 patients with COPD were divided into 2 groups depending on the severity of bronchial obstruction. A deficiency of vitamin D was significantly more prevalent in COPD patients with GFRcys <60 ml/min/1,73 m2 compared to patients with preserved renal function. A medium positive correlation of vitamin D levels with the severity of bronchial obstruction (r=0,419, p=0,001), medium negative correlation of vitamin D levels with exacerbation frequency (r=0,421, p=0,01) and CRP (r=0,301, p=0,02) were observed. Significant negative correlation of vitamin D levels with the magnitude of albuminuria (r=0,345, p=0,02) was also discovered. Significant lower relative frequency of hyperphosphatemia in patients with COPD 3, 4 severity (63,16 vs 78,69%, χ2=6,627, p<0,05), there was a positive correlation between the phosphorus level of the blood serum level of 25(ОН)D (r=+0,475, p=0,025).The level of vitamin D in some clinical situations can be considered as a promising biomarker of current cardiorenal continuum in patients with COPD, and its correction, as a possible way of slowing the progression of cardiovascular complications in such patients.

[Improvement of the efficacy of treatment of hypertensive encephalohathy by using mexidol]. / Povyshenie éffektivnosti lecheniia gipertonicheskoi éntsefalopatii preparatom meksidol.

AIM: To assess the efficacy and tolerability of mexidol used to improve cognitive impairment in patients with hypertension and clinical manifestations of chronic cerebral circulatory insufficiency. MATERIAL AND METHODS: Forty-two patients with chronic cerebral circulatory insufficiency and cognitive impairment were examined. MMSE, МоСА and the clock drawing test were used to assess neuropsychological status. The Morisky-Green test was administered to evaluate medication adherence. Patients were stratified into two groups: patients of the first group (n=21) received standard treatment. Patients of the second group (n=21) received additionally mexidol in dose 200 mg (4 ml) in 100 ml of NaCl isotonic solution intravenously during 10 days and then in tablets (2 tablets 0,125 mg) twice a day during 8 weeks. RESULTS: According to the 4-item Morisky Medication Adherence Scale (MMAS), 31% of respondents were not adherent to the treatment (MMAS score 0-2), 35.7% (n=15) of patients showed high adherence (MMAS score 4), 33.3% (n=14) demonstrated low adherence (MMAS score 3). The average score on the questionnaire was 2.85. In patients treated with mexidol, the absence of complaints increased by 3 times and headache regression increased by 90%. The improvement of memory, concentration and anxiety was observed in 50%, 55%, 67% of patients, respectively. Patients treated with mexidol demonstrated more significant changes during the clock drawing test. The average change in the scores increased by 0.95 compared to the control group, where the changes were 0.54 (p<0.02). The positive dynamics on MMSE and МоСА was shown in the mexidol group that indicated the positive effect of this drug on cognitive symptoms. CONCLUSION: The positive impact on cognitive symptoms and health in patients with chronic cerebral circulatory insufficiency allows to recommend mexidol as add-on to standard treatment of the main disease.

[Terminological and demographic aspects of comorbidity].

The aim of the present review is to bring into focus the issues regarding terminological and demographic aspects of comorbidity we come across in the modern literature. In this review we gave definitions for the most widely used terms «comorbidity¼, «polymorbidity¼, and «multimorbidity¼. We also considered the historical aspects of their origin and showed the differences between the concepts. The interaction of illnesses can modify the clinical picture and course of illnesses, the nature and severity of complications, reduce the length and quality of life of the patient. The number of comorbid conditions increases significantly with age and contributes to the development of multiple functional disorders leading to polyfunctional failure. In order to choose the most appropriate diagnostic and treatment pattern in elderly and senile patients, it is necessary to take into account all chronic conditions (somatic and mental) accumulated by the patient throughout his life. In order to assess the prevalence and impact on population prognosis and to make health care costs estimation it is more appropriate to use the terms «comorbidity¼ and «multimorbidity¼.

[Chronic kidney disease: contribution to comorbidity in elderly patients with chronic obstructive pulmonary disease].

The aim was to study the prevalence of risk factors for chronic kidney disease (CKD) and frequency of CKD in patients with chronic obstructive pulmonary disease (COPD). 300 patients with a diagnosis of COPD I-IV were examined. A high prevalence of risk factors CKD was revealed, there are close correlations between the risk factors and the age of patients and severity of obstructive disorders and the spectrum of comorbid pathology. The diagnosis of CKD 1-3B stage is set for 47,6 % of the patients. The obtained data determine the necessity of close attention by clinicians to the study of renal function in elderly patients with COPD.

[Nutrition in obesity: Target criteria and monitoring of weight loss]. / Pitanie pri ozhirenii: tselevye kriterii i monitoring snizheniia massy tela.

The review paper gives in details the current clinical guidelines for evaluation of the impact of nutrition on the correction of increased body mass index (BMI) and obesity, an overview of the efficacy of specific commercial diets, target criteria for weight loss, and monitoring the status of a patient who participates in a weight loss program. The current clinical guidelines suggest that today there is no optimal diet in terms of its impact on the correction of overweight and further maintenance of the weight loss achieved. There is a need for both the improvement of the professional capacity of healthcare workers in advising patients about nutrition and the population's awareness about the principles of a healthy diet. The complex nature of the problem requires that a medical community should interact closely with politicians to make a legislative decision on a number of issues relating to healthy eating.

[The relationship between regional levels of mortality of ischemic heart disease and social economic factors in the Russian Federation].

The study was carried out to evaluate input of particular indices considered by Rosstat into indices of mortality of ischemic heart disease in three age groups at regions of the Russian Federation in 2003-2013. The data base of the Institute of demographic studies of the Russian Economic School was used as the source of data concerning mortality of ischemic heart disease and myocardium infarction. The panel data analysis was applied to form panel of 800 observations (on every variable) i.e. on 80 subjects of the Russian Federation in 2003-2012. The base «United inter-sectoral informational statistical system" was used as source of factorial indices. It is established that the most significant impact on mortality of ischemic heart disease, including of myocardium infarction, is render such stress factors as alcohol abuse and urban residence at that this dependence only increases with age. The number of physicians and per capita level of gross value added demonstrate negative correlation with mortality of ischemic heart disease in all age groups both in males andfemales. The level of consumption of carbohydrates (grams per day) correlates positively with mortality of ischemic heart disease and negatively with mortality of myocardium infarction in all groups. The application of non-typical techniques of mathematical statistics is necessary for more accurate evaluation of factors effecting level of mortality of ischemic heart disease. From methodological point of view, the most proper is carrying out of prospective cohort studies.

[Acetylsalicylic acid for the prevention of primary myocardial infarction and ischemic stroke].

There is evidence that acetylsalicylic acid (ASA) is effective in preventing events in a number of cardiovascular diseases. However, there is a number of unresolved problems concerning the efficiency and suitability of its use as an agent for the prevention of cardiovascular events (CVEs) (myocardial infarction (Ml) and/or ischemic stroke (IS) and/or death) in subjects without any clinical manifestations and/or diagnosed coronary heart disease (primary prevention of CVEs). The aim of the review is to compare the current recommendations of, professional communities for the.use of ASA as an agent for the primary prevention of CVEs, to analyze cohort studies and meta-analyses that are not included in the above recommendations (2013-2014), and to consider particular issues on ASA administration (resistance to ASA; barriers to its preventive use). The analysis performed suggests that there is no convincing evidence that it is reasonable to use ASA as a population-wide prevention strategy. The studies and meta-analyses often show conflicting data, which is likely to be associated with the clinical features of population groups included in the studies, with the presence or absence of ASA resistance and motivation for therapy. According to the current clinical recommendations, the results of studies and meta-analysis, and expert's opinions, deciding whether it is expedient to use ASA as an agent for the prevention of primary MI and/or IS and death from atherosclerostic vascular events should be based on the assessment of an individual's risks for the above disorders, which are related to a risk for hemorrhages due to ASA intake.

[Paradox of Obesity and Cardiovascular Mortality].

Obesity is known as an independent risk factor of a number of chronic noninfectious disorders, however some investigations testify to the presence of "obesity paradox". The aim of the present review was to analyze results of investigations purposed to assess the effect of an elevated body mass index (BMI) and obesity on hospital mortality, risk of complications, and long term prognosis (mortality rate). Effect of BMI dynamics during lifespan on (cardiovascular ?) mortality was also analyzed. The results failed to demonstrate any convincing evidences that BMI 25-35 kg/m2 alone without taking into consideration metabolic changes, waist measurements, correlation between fat and muscular tissue was a risk factor of higher mortality in the long-term prospect and that its decrease improved survival. At the same time, it should be noted that these results depended on the method of sample formation and approaches to the statistical analysis.

[Comparative efficacy of choline antagonists in chronic obstructive lung disease].

The efficacy of thiotropium bromide, 18 microg/day, versus ipratropium bromide, 160 microg/day, was studied in 20 patients with chronic obstructive lung disease (COLD) treated with a drug for 4 weeks. Clinical and spirographic parameters and arterial blood gas composition were determined. According to clinical and spirographic data, thiotropium bromide has some advantage over ipratropium. Both test drugs improved blood gas composition.

[Efficacy of telmisartan in chronic obstructive lung disease wtih arterial hypertension].

The study included evaluation of respiratory function, bronchial conductivity, gas homeostasis, and 24-hour profile of blood pressure (BP) in 15 male patients with chronic obstructive lung disease and I-II stage arterial hypertension prior to and after 2 weeks of therapy with telmisartan. The drug, administered in a dose of 80 mg/day, significantly increased 1 sec forced expiratory volume, peak expiratory flow rate, decreased effective bronchial resistance and CO2 partial pressure in arterial blood. Telmisartan also significantly reduced mean systolic BP (SBP) (p < 0.003) and diastolic BP (DBP) (p < 0.001) during day hours, SBD (p < 0.01) and pulse BP (p < 0.05) during night hours, significantly reduced SBP load (p < 0.02) and DBP load (p < 0.003) during day hours, and SBP load during night hours (p < 0.02).

[Physical exercise in secondary prevention of coronary heart disease].

Addition of life style intervention to pharmacological therapy has been shown to be essential for secondary prevention of cardiovascular diseases. The American Heart Association and American College of Sports Medicine propose physical activity of moderate intensity using dynamic exercise not causing myocardial ischemia and recommend four to five training sessions (30-40 min each) per week. Such activity has been shown to improve prognosis in coronary heart disease. This can be explained by exercise induced improvements of cardiovascular risk factors e.g. dyslipoproteinemia, insulin resistance and inflammation, normalization of endothelial function and retardation of atherosclerosis. Because of the strong evidence of the benefit of exercise in cardiovascular prevention and rehabilitation, this approach should be included in the complex therapy of cardiovascular patients.