DisclaimerThe EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

This paper summarizes the data from updated international protocols and guidelines for diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM). The invasive and non-invasive diagnosis techniques and their combinations are briefly reviewed; the evidentiary foundations for each diagnostic option and tool are analyzed. The paper describes a customized algorithm for sequential diagnosis and differential diagnosis of patients with suspected ATTR-CM with allowance for the combination of clinical signs and diagnostic findings. Along with the awareness of primary care providers about the red flags of the disease and visualization criteria, as well as providing information to the patients about the possibility of performing therapy of ATTR amyloidosis and the risks of delayed diagnosis, the proposed algorithm enables timely patient routing and prescribing specific treatment.

Obesity is an independent predictor of cardiovascular diseases (CVD), including heart failure (HF). Nevertheless, numerous studies have shown that patients with CVD who are overweight and slightly obese have a better short-term and moderate prognosis than thinner patients with CVD. This phenomenon has been called the obesity paradox. Understanding the obesity paradox is important in patients with HF, given the high prevalence of obesity in patients with HF. The article presents an overview of clinical studies devoted to the study of obesity as a risk factor for HF, the pathogenesis of HF in obesity, and highlights the issues of the obesity paradox and the treatment of obesity in this category of patients.

В статье приведены избранные тезисы из 4-го издания монографии «Дислипидемии, атеросклероз и ишемическая болезнь сердца», посвященные основным аспектам патогенеза, факторов риска, диагностики и терапии атеросклероза и дислипидемий. Представлены новые подходы к этим проблемам и изменения, которые также нашли отражение в рекомендациях VII пересмотра, подготовленных Национальным обществом по изучению атеросклероза. К ним относятся введение категории пациентов экстремального риска, коррекция значений целевых уровней холестерина липопротеидов низкой плотности, трансформирование интерпретации значений баллов по шкале SCORE, акцент на различные фенотипы атеросклероза, коморбидность и мультиморбидность, а также более широкое применение в липидологической практике ингибиторов PCSK9.

Reducing the risk of cardiovascular complications include lifestyle changes, drug therapy for achieving target blood pressure levels, normalizing the lipid profile, and correcting other risk factors. Adherence to therapy is of particular role, especially in primary prevention, which determines the need to implement the concept of fixed combinations. Approximately 70% of patients with AH have elevated levels of total cholesterol (TCh) and LDL-C, which determines the feasibility of using a FC containing a statin with two antihypertensive drugs. Aim. The aim of the study was to assess cardiovascular risk in patients with elevated levels of total cholesterol and LDL-C and concomitant AH, a comparative analysis of adherence, efficacy and safety of various forms of combined therapy in outpatient practice, including promising lisinopril/amlodipine/rosuvastatin FC (Ekvamer®). Materials and methods. The ANICHKOV study included 702 patients in Moscow and the Moscow region over 18 years old with a ­chole­sterol level ≥7.5 mmol/l and/or LDL-C ≥4.9 mmol/l from March 2017 to December 2018 based on 2 federal centers. According to the results of visit I, patients were prescribed with one of three therapy schemes. In the absence of AH, patients received scheme I ­(Mertenil® at initial dosage of 10 mg/day). When history of AH existed or AH detected at visit I, patients were randomized to scheme II ­(Ekvamer® 5/10/10 mg/day) or III (Mertenil® 10 mg/day + Ekvator® 5/10 mg/day). During the observation, the treatment scheme remained unchanged, however, if the target levels of LDL-C and/or BP were not reached, the doses could be increased. The analysis of the main effects of the prescribed therapy were carried out for 12 months, and the frequency of MACE (CVD, ACS, stroke, or hospitalization to perform PCI) was also evaluated Results and discussion. Following the visit I, scheme I was assigned to 390 patients (55.6%), scheme II – 190 (27.1%), scheme III – 122 (17.4%). In 147 patients (20.9%), TG level was >2.3 mmol/l, which required additional fenofibrate intake in a dose of 145 mg/day. Adherence level was 89.5%, including scheme I – 91.7%, scheme II – 90.5%, scheme III – only 81.8%. In general, among compliant patients (n = 590), the decrease in TCh level was 41.0%, LDL-C – 47.4%. 16.6% of patients reached target levels of LDL-C <2.5 mmol/l, 5.6% – <1.8 mmol/l. In the fenofibrate subgroup, TG level decrease was 34.6%. During the follow-up period, 47 cases of side effects were observed in 27 patients (4.6%), that did not require modification of therapy. Systolic BP reduction in compliant patients of schemes II and III was 20 mm. Hg (13.1%), diastolic BP – 12 mm. Hg (13.6%), target BP levels (<140/90 mm. Hg) reached 83.7% and 80.8% of patients, respectively, target levels of BP and LDL-C <2.5 mmol/l reached 14.5% and 13.1% of patients, respectively, <1.8 mmol/l – 5.8% and 5.1%, respectively. During the observation period no deaths were recorded, other components of MACE were observed in 38 patients (5.8%), including 27 among compliant patients (4.6%) and 11 among non-compliant (15.9%, p<0.01). In 19 out of 38 patients (50%), hospitalization for routine PCI was the end point, ACS – in 12 (31.6%), and stroke – in 7 (18.4%). Conclusion. The results of the study demonstrated a sufficient hypolipidemic effect and high safety of Mertenil® and Ekvamer®. A higher adherence to the combined preparation than to two monodrugs was noted. Achieving target levels of BP and LDL-C is problematic, which dictates the expediency of using fixed combinations of drugs, especially in primary prevention. Keywords: combined antihypertensive therapy, lipid-lowering therapy, high cardiovascular risk

Aim. To evaluate the efficacy, safety and effect on the prognosis of cardiac contractility modulation (CCM) in patients with chronic heart failure (CHF) with reduced left ventricular ejection fraction and atrial fibrillation compared with the group of only optimal drug therapy (ODT) of the 12-month follow-up. Materials and methods. Patients (n=200) were sequentially included in two groups: group 1 patients with CHF who are on ODT in combination with implanted CCM devices (n=100), group 2 comparison patients with CHF who receive only ODT (n=100). Initially and after 12 months, 12-channel electrocardiography (ECG), transthoracic echocardiography, daily ECG-monitoring, determination of the level of NT-proBNP, a six-minute walk test and an assessment of the quality of life according to the Minnesota Questionnaire were performed. Results. In the CCM therapy group, a significant clinical improvement was revealed, which was expressed in the form of a decrease in functional class CHF by NYHA (New York Heart Association), an increase in the distance of a six-minute walk test and an improvement in the quality of life according to Minnesota Questionnaire, as well as an improvement in left ventricle contractile function compared to the ODT group. The absence of a proarrhythmogenic effect of the CCM was shown. There was a significant decrease in the frequency of the readmission due to CHF and the probability of achieving the combined endpoint in the CCM therapy group compared with only ODT. Conclusion. The use of CCM in patients with CHF and atrial fibrillation is an effective and safe method of therapy that leads to the development of reverse remodeling of the myocardium, improves the clinical status of patients and reduces the frequency of readmission due to decompensation of CHF.