Оценка влияния применения лекарственного препарата тикагрелор у пациентов с острым коронарным синдромом на целевые показатели федерального проекта “Борьба с сердечно-сосудистыми заболеваниями”

Aim. To evaluate the effect of the use of the double antiplatelet therapy (DAT) with ticagrelor compared to DAT with clopidogrel and antithrombotic therapy with acetyl salicylic acid (ASA) in patients with acute coronary syndrome and patients with high coronary risk on the target indicator (CP) of the state program (GP) “Development of Healthcare” and the federal project “Fight against cardiovascular diseases” — reducing mortality from diseases of the circulatory system (BSC).Material and methods. All adult Russian patients with a diagnosis of ACS eligible for DAT were considered as the target population; in the second and third years, only patients with high coronary risk continued treatment. The calculation of the number of deaths that can be prevented using DAT ticagrelor 90 mg + ASA vs DAT of clopidogrel + ASA within 1st year from the date of diagnosis was based on the clinical efficacy data of the PLATO study. The number of deaths that can be prevented with the use of DAT ticagrelor 60 mg + ASA — instead of ASA monotherapy patients with a history of myocardial infarction was made based in the clinical efficacy results of the PEGASUS study. It was calculated what proportion of the target indicators could be achieved in 2022-24 years by using DAT with ticagrelor instead of clopidogrel or ASA monotherapy.Results. The use of DAT with ticagrelor vs DAT with clopidogrel or ASA for the treatment of patients with ACS will prevent additional 5389, 5704 and 6012 deaths in 2022-2024, that will ensure the implementation of the CP “reduction of mortality from BSC” GP “Development of healthcare” in the Russian Federation by 36,9%, 26,0% and 20,6% respectively.Conclusion. The use of DAT with ticagrelor for the treatment of patients with acute coronary syndrome ensure the implementation of the CP “reduction of mortality from BSC” GP “Development of healthcare” in the Russian Federation in 2024 by 20,6%.

Aim. To assess the effect of dapagliflozin in patients with heart failure with reduced ejection fraction (HFrEF) on reducing cardiovascular mortality as the main goal of a federal project on the prevention of cardiovascular diseases. Material and methods. All adult Russian patients with a documented NYHA class II-IV HFrEF (EF £40%) were considered the target population. The characteristics of the patients corresponded to those of the Russian Hospital Heart Failure Registry (RUS-HFR). The study looked at an increase in the dapagliflozin use in addition to standard therapy by 10% of patients annually in 2021-2023 and calculated the number of deaths that could be prevented. Cardiovascular mortality curve was created by extrapolation of the DAPA-HF study results using the Kaplan-Meier method. Further, the contribution of prevented deaths with dapagliflozin to the achievement of regional and federal targets for reducing cardiovascular mortality was calculated for 1, 2, and 3 years. Results. In case of 10% annual increase in dapagliflozin use in patients with NYHA class II-IV HFrEF, this will allow: — to prevent an additional 1,736 cardiovascular deaths in the first year, achieving the target of federal project on the prevention of cardiovascular diseases in 2021 by 5,9%; — to prevent an additional 3,784 cardiovascular deaths in the second year, achieving the target of federal project on the prevention of cardiovascular diseases in 2022 by 12,9%; — to prevent an additional 5,485 cardiovascular deaths in the third year, achieving the target of federal project on the prevention of cardiovascular diseases in 2023 by 18,7%. Conclusion. The use of dapagliflozin in patients with HFrEF will reduce mortality from cardiovascular diseases.

Aim. To assess the effect of therapy with sodium glucose co-transporter type 2 inhibitor dapagliflozin in patients with heart failure with reduced ejection fraction (CHrEF) on the state cardiovascular mortality target indicators.Material and methods. All adult Russian patients with NYHA class II-IV HFrEF (left ventricular ejection fraction ≤40%) were considered as the target population. The characteristics of patients in the study corresponded to those in the Russian Hospital HF Registry (RUS-HFR). The study suggests that the use of dapagliflozin in addition to standard therapy will be expanded by 10% of the patient population annually in 2022-24. Cardiovascular mortality modeling was performed based on the extrapolation of DAPA-HF study result. The number of deaths that can be prevented was calculated when using dapagliflozin in addition to standard therapy. Further, the contribution of prevented deaths with dapagliflozin therapy to the achievement of federal and regional cardiovascular mortality target indicators (1, 2 and 3 years) was calculated.Results. The use of dapagliflozin in addition to standard therapy for patients with NYHA class II-IV CHrEF with the expansion of dapagliflozin therapy by 10% of the patient population annually will additionally prevent 1729 cardiovascular death in the first year. This will ensure the implementation of cardiovascular mortality target indicators in Russia in 2022 by 11,8%. In the second year, 3769 cardiovascular deaths will be prevented, which will ensure the implementation of target indicators in 2023 by 17,2%. In the third year, 5465 cardiovascular deaths prevented, which will ensure the implementation of implementation of target indicators in 2024 by 18,7%.Conclusion. The use of dapagliflozin in addition to standard therapy for patients with NYHA class II-IV CHrEF will ensure the implementation of implementation of target indicators in 2024 by 18,7%.

OBJECTIVE: Clinical and economic evaluation of using the dapagliflozin in addition to standard therapy for patients with CHF (Chronic Heart Failure) and concomitant type 2 DM (Diabetes mellitus).MATERIALS AND METHODS: All adult Russian patients with confirmed diagnosis of CVD and concomitant type 2 DM were considered as the target population. We evaluated the use of dapagliflozin in addition to standard therapy in comorbid patients with CHF and DM type 2 on the indicators of CC death, death from any cause of hospitalization due to CHF, emergency treatment due to CHF, as well as calculated the cost per life year saved and quality-adjusted life year (QALY) saved both when using standard therapy alone and in combination with dapagliflozin.RESULTS: The use of dapagliflozin in addition to standard therapy for the treatment of comorbid patients with CHF and DM 2 per cohort of 1,000 people will prevent an additional 1,3 and 10 years: CHD-related hospitalizations: 40, 99, 195, respectively; Emergency admissions due to CVD: 15, 38, 73 respectively; CC deaths: 9, 19, 25 respectively; Deaths from any cause: 10, 21, 19 At the same time, the costs per one year of quality-adjusted life saved were 1,923,509 rubles during the first year, 1,102,680 rubles during the first 3 years, and 560,841 rubles for 10 years, which did not exceed the calculated value of the willingness-to-pay threshold — 3.14 million rubles, and allowed us to conclude that dapagliflozin is clinico-economically feasible in the studied patient population.CONCLUSION: The use of dapagliflozin in addition to standard therapy for the treatment of comorbid patients with CHF and type 2 diabetes is clinically and economically feasible, considering the cost per year of life saved, adjusted for quality of life.

Phytoestrogens in combination with nutraceuticals are often used as a non-hormonal strategy for managing menopausal symptoms. The evidence base for the effectiveness of phytoestrogens remains controversial, which is due to the presence of several compounds of different chemical classes and levels of phytoestrogenic activity. The design of clinical trials (inadequate dosage, short observation period, small sample size, group heterogeneity) may be the reason for the result of insufficient efficacy. The effects of phytoestrogens on the reproductive system have been confirmed by preclinical studies. Phytoestrogens are considered as protectors of hormone-dependent proliferative processes and as agents for preventing cardiovascular diseases and reducing cardiometabolic risks in women with low estrogen levels. Data from a systematic review of compounds with high activity (genistein, daidzein, isoxanthohumol, biochanin A and B) have shown that phytoestrogens reduce hot flashes even with the placebo effect. The literature provides evidence for statistical and clinically significant efficacy of using a standardized red clover extract containing isoflavones to relieve menopausal symptoms. The effectiveness increases when it is synergistically combined with other micronutrients. Key words: phytoestrogens, red clover, flaxseed, menopause