[The program of lowering of residual risk (the residual risk reduction initiative). Part I. Factors of residual risk].

Substantial residual risk of development of macro- and microvascular complications is retained in most patients despite contemporary standards of therapy. The search for the solution of actual problem of lowering of residual risk of vascular complications is the aim of multiple current scientific studies conducted in medical practice of the world. The program Residual Vascular Risk Reduction Initiative (R3i) was called upon to join efforts of medical professionals and patients from different countries for solution of the global problem of residual risk of development of vascular complications. In the review we describe objective and main directions of activity of this project. We also give characteristics of individual component factors of residual risk of development of vascular complications investigated in the framework of the R3i program as well as possible methods of improvement of their correction.

[Evidence-based grounds of the efficacy of simvastatin (zocor): 15 years later].

The review describes the history of hypolipidemic therapy with statins. It gives the results of studies of the primary prevention of atherosclerosis and the treatment of hyperlipidemias with lovastatin, pravastatin, and fluvastatin. Emphasis is laid on trial data on the efficacy, tolerability, and safety of simvastatin (zocor). The results of studies, including regression ones, of this drug in different doses, controlled by biochemical, clinical, magnet resonance imaging, and ultrasonic data are summarized. There is a significant reduction in the risk of cardiovascular, coronary, and overall deaths and in that of stroke. There is evidence for the successful use of simvastatin (zocor) in combined therapy with fibrates, nicotinic acid, and ezetrol.

[Randomized FARVATER study. Part 2. Effect of atorvastatin on endothelial function, distensibility and stiffness of vascular wall].

AIM: To elucidate effect of two doses of atorvastatin (10 and 20 mg/day) on endothelial function, distensibility and stiffness of vascular wall. MATERIAL AND METHODS: Patients (n=50) with documented ischemic heart disease and hyperlipidemia were randomized to 10 or 20 mg/day of atorvastatin (Atoris, KRKA). Endothelial function and common carotid artery wall distensibility and stiffness were assessed at baseline and after 12 and 24 weeks of treatment. RESULTS: Administration of both 10 and 20 mg/day doses of atorvastatin for 6 weeks was associated with significant lowering of total cholesterol (CH), triglycerides (TG) and low density lipoprotein (LDL) CH (24.5, 18.4, 34.9% and 29.1, 28.2, 40.9%, respectively). After 24 weeks LDL CH lowering from baseline reached 34.9 and 43.9% (p<0.001) and that of TG - 22 and 15%, in 10 and 20 mg/day groups, respectively. There were no significant differences between 10 and 20 mg/day groups in baseline values of endothelium dependent vasodilation (EDV), carotid artery distensibility and stiffness (7.28 and 6.64%, 21.60 and 20.15, 8.04 and 9.19 U, in 10 and 20 mg/day groups, respectively). After 3 months of treatment there occurred significant 38.4% (10 mg/day) and 45.4% (20 mg/day) increases of EDV. Significant 27.6% (10 mg/day) and 28.8% (20 mg/day) enhancement of vascular distensibility was noted after 24 weeks. Vascular wall stiffness decreased 33.4% (p=0.008) and 31.3% (p=0.002) in 10 and 20 mg/day groups, respectively.

[Randomized FARVATER Study. Part 1. Effect of 10 and 20 mg/day atorvastatin on levels of lipids, C-reactive protein, and fibrinogen in patients with ischemic heart disease and hyperlipidemia].

Main aim of the clinical study FARVATER was comparison of effects of 10 and 20 mg/day of atorvastatin on levels of lipids, high-sensitivity C-reactive protein (CRP), fibrinogen (F), and structural-functional state of vascular wall in patients with documented and primary hyperlipidemia (HLP). Fifty patients (mean age 60.8 years) with documented ischemic heart disease and HLP were randomized to continuous administration of 10 and 20 mg/day atorvastatin for 24 weeks. Initial levels of total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDLCH), high density lipoprotein cholesterol (HDL CH), CRP and F were 6.22, 1.86, 4.15, 1.24 mmol/l, 1.46 and 2.93 g/l, respectively. After 6 weeks lowering of TCH, TG and LDLCH was significant both in 10 (24.5, 18.4, and 34.9%, respectively) and 20 mg (29.1, 28.2, and 40.9%, respectively) groups. After 24 weeks TG levels decreased by 22 and 15% in 10 and 20 mg subgroups, respectively. Changes of HDLCH (+11 and +12% in patients treated with 10 and 20 mg, respectively) were not significant. There were no significant changes of CRP and F levels. Seven side effects (4%) were registered during 24 weeks; 2 were related to study drug (allergy and symptomless elevation of creatine kinase).

[Simvastatin (40 mg/day) in patients with hereditary hypercholesterolemia: effect on high density lipoprotein cholesterol]. / Simvastatin v doze 40 mg/sut pri lechenii bol'nykh s nasledstvennoi giperkholesterinemiei: vliianie na uroven' kholesterina lipoproteinov vysokoi plotnosti.

AIM: To study effect of simvastatin of the level of high density lipoprotein (HDL) cholesterol (CH). MATERIAL AND METHODS: Simvastatin (40 mg/day) was given for 3 months to 15 patients (3 men, 12 women, mean age 56-/+10.3 years) with hereditary type II hypercholesterolemia after washout from lipid lowering therapy. Initial level of HDL CH was below and above 1.0 mmol/l in 7 and 8 patients, respectively. Blood lipids, activity of liver enzymes and creatine kinase were determined after 1 and 3 months of therapy with simvastatin. Safety and tolerability of simvastatin were also studied. RESULTS: Simvastatin was well tolerated. In 1 patient the drug was stopped because of pain in the liver and nausea. In patients with initially low HDL CH levels of total and low density lipoprotein (LDL) CH significantly decreased by 29.6 and 36.8%, respectively, after 3 months, while level of HDL CH increased by 20% after 1 month of therapy. In patients with initially normal HDL CH levels of total and LDL CH significantly decreased by 31.1 and 32.6%, respectively, while those of triglycerides and HDL CH did not change. CONCLUSION: In patients with hereditary hypercholesterolemia 40 mg/day of simvastatin besides pronounced lowering of LDL CH level caused significant increase of HDL CH (up to 20% in 1 month) in patients with initially low level of this parameter.