Aleksei A. Nekrasov

Aim. To evaluate lipid metabolism dynamics by switch from inclisiran to alirocumab in the setting of lipid-lowering therapy (LLT) after acute coronary syndrome (ACS). Materials and methods. 26 patients survived ACS with low-density lipoprotein cholesterol (LDL-C) ≥ 4.0 mmol/L during hospitalization were included. All patients were prescribed inclisiran within 6 months after ACS. Each patient received it at least twice. All patients were expected to undergo an unplanned switch from inclisiran to alirocumab due to logistical reasons. All patients gave consent to participate in the study. Eight visits were conducted to assess LDL-C levels: 3 and 1 month before the end of inclisiran therapy, on the day of the first alirocumab injection and 1, 2, 3, 4, and 5 months after the start of alirocumab therapy. Results. LDL-C values (Me [Q1; Q3]) during the inclisiran treatment period (visits 1–3) were 1.34 [0.55; 1.41], 1.44 [0.53; 2.00], 1.67 [1.08; 1.96] mmol/l and during alirocumab treatment (visits 4–8) – 1.10 [0.61; 1.55], 0.95 [0.69; 1.40], 1.01 [0.86; 1.55], 0.88 [0.71; 1.53], 0.87 [0.70; 1.22] mmol/l (p = 0.002). The first administration of alirocumab at visit 3 was associated with the greatest reduction in LDL-C over the month (-34.1%; p = 0.001). Conclusion. The switch from inclisiran to alirocumab in post-ACS patients resulted in a rapid LDL-C reduction without any adverse events.

Aim. To evaluate the effect of the initiation time of lipid-lowering therapy (LLT) with the use of the proprotein convertase subtilisin/kexin type 9 (iPCSK9) inhibitor alirocumab on the incidence of adverse outcomes during 18-month follow-up after acute coronary syndrome (ACS). Materials and methods. Two groups of patients were observed. In both groups iPCSK9 alirocumab was prescribed within a year after ACS as part of multicomponent LLT: Group 1 (n=20) – alirocumab therapy was started 3 or more months after ACS, Group 2 (n=18) – alirocumab was started up to 3 months after ACS. Control visits were performed at 3, 6, 12 and 18 months after ACS to assess the character of LLT, long-term outcomes and dynamics of low-density lipoprotein cholesterol. Results. In groups 1 and 2, the proportions of those who achieved the target low-density lipoprotein cholesterol after 6 and 12 months, respectively, were 40.0 and 83.3% (p=0.008), 55.0 and 88.9% (p=0.024). A more than three-fold decrease in the need for rehospitalizations for any and cardiovascular reasons was noted among patients with an earlier start of PCSK9-targeted therapy. The need for cardiovascular hospitalizations directly correlated with the period (number of months) before alirocumab was prescribed (R=0.44; p=0.006). Conclusion. The use of alirocumab as a part of outpatient low-density lipoprotein cholesterol LLT provides a powerful corrective effect on the lipid profile, as well as an improvement in long-term outcomes after ACS. The positive results of this therapy are especially noticeable when it is started within 3 months after the cardiovascular event.

Aim. To evaluate the effectiveness of lipid-lowering therapy (LLT) administered in the lipid center to patients with acute coronary syndrome (ACS) and severe dyslipidemia, and to study its impact on prognosis.Material and methods. Over 18 months, 81 patients after ACS with low-density lipoprotein cholesterol (LDL-C) >3,9 mmol/L during hospitalization were followed up. Upon discharge, all were proposed for LLT at the lipid center; 53 (Group 1) refused and 28 (Group 2) agreed. At control visits after 3, 6, and 12 months, LDL-C and LLT characteristics were assessed in both groups. After 18 months, adverse outcomes (death, rehospitalizations) were assessed.Results. LLT in lipid center was characterized by earlier and more frequent use of combination therapy. PCSK9-targeted therapy in case of failure to achieve LLT targets by other means was initiated in lipid center 3,6 times more often (p=0,00001) and 2,2 times faster (p=0,003) than in routine outpatient practice. At the visit 3 months after ACS, the target LDL-C level was met by 14,7% of patients in the 1st group and 25% of patients in the 2nd group (p=0,24), while 6 months after ACS — 18,4% and 63% of patients (p=0,005), and after a year — 20% and 85,7% of participants, respectively (p=0,00001). The rationale of using lipid center as a basic institution for LLT was confirmed by an improved prognosis according to a 18-month followup (especially with regard to rehospitalizations, which occurred 5,8 times less frequently than in outpatient practice, p=0,00001). The time before the start of PCSK9 inhibitors directly correlated with the need for rehospitalizations during further follow-up (R=0,46; p=0,007). In the first 12-month therapy, the hypolipidemic effect of inclisiran and monoclonal antibodies (alirocumab, evolocumab) in patients after ACS was comparable.Conclusion. Lipid center is one of the divisions of medical facilities that have great potential for qualified support of LLT in patients with ACS and severe dyslipidemia. On its basis, a high compliance of medical measures with current clinical guidelines can be ensured.

Introduction. Uncorrected dyslipidemia worsens the prognosis after acute coronary syndrome (ACS). The effective lipid-lowering therapy (LLT) may be important including proprotein convertase subtilisin/kexin type 9 inhibitors (iPCSK9). There is not enough data about the effect of iPCSK9 initiation time on ACS outcomes.Aim. To evaluate the effect of iPCSK9 initiation time on ACS outcomes during 18 months of follow-up.Materials and methods. We observed 33 consecutive patients discharged from the hospital who met the following criteria: 1) hospitalization with ACS, 2) low-density lipoprotein cholesterol (LDL-C) > 3.9 mmol/l, 3) consent to visits at 3, 6, 12 and 18 months after ACS, 4) initiation of iPCSK9 therapy within a year after discharge. In 17 patients iPCSK9 therapy was initiated ≥3 months (group 1), and in 16 patients – Results. 6 and 12 months after ACS the proportions of individuals with target LDL-C values in group 2 were 2.3 (p = 0.009) and 1.6 (p = 0.024) times higher than in group 1. In groups 1 and 2, the proportions of individuals requiring cardiovascular rehospitalizations were 9 (52.9%) and 2 (12.5%), respectively, p = 0.017. There were no fatal outcomes. The need for rehospitalizations was inversely correlated with the early start of PCSK9-targeted therapy (R = -0.47; p = 0.0001) as well as with the treatment at the lipid center (R = -0.42; p = 0.0004).Conclusions. Early initiation of iPCSK9 is associated with rapid achievement of target LDL-C values in ACS survivors and 4.2-fold reduction in the need for cardiovascular rehospitalizations. The use of a lipid center as a basic institution for LLT also contributes to the lower need for rehospitalizations.

Patients with coronary artery disease (CAD) and diabetes are identified as a high cardiovascular risk group both in Russia and abroad. Having similar paths of development and progression of atherosclerosis and atherothrombosis, these diseases potentiate each other's thrombogenesis mechanisms. As a result, cardiovascular ischemic events occur, making a significant contribution to the mortality rates of this group of patients. Influencing the risk of thrombus formation is one of the key links on the way to improving the prognosis of patients with CAD and diabetes. Modern antithrombotic therapy, including not only the antiplatelet agent aspirin, but also the anticoagulant rivaroxaban at a dose of 2,5 mg, allows for the maximum impact on the development of atherothrombosis, thereby reducing the risks of cardiovascular events and all-cause death. The aim of the review was to analyze the potential of reducing the all-cause death risk by prescribing the main drug groups that are part of the therapy of patients with CAD and diabetes.

Aim. To study the gender and age characteristics of dyslipidemia in the population of the Nizhny Novgorod region.Material and methods. A total of 2501 people aged 35-74 among the population of the Nizhny Novgorod region were examined, selected by stratified multi-stage random sampling. The study was performed as part of the third epidemiological study ESSE-RF3. All respondents underwent an anthropometric survey, a questionnaire to identify chronic non-communicable diseases and related risk factors. The following laboratory tests were performed: total cholesterol (TC), low-density lipoproteins (LDL-C), high-density lipoproteins (HDL-C), triglycerides (TG). Among the entire cohort of patients at the time of blood sampling, 276 people (11,0%) were receiving lipid-lowering drugs. They were excluded from further analysis. Hypercholesterolemia (HCL) was recorded with a total cholesterol ≥5,0 mmol/l, an increased level of LDL-C — with a level ≥3,0 mmol/l, hypertriglyceridemia (HTG) — with a TG ≥1,7 mmol/l, a reduced level of HDL-C — with a level in males ≤1,0 mmol/l, in women ≤1,2 mmol/l.Results. The prevalence of HCL was 65,1%. In the young cohort (40-44 years), men were significantly more likely to have hypercholesterolemia, but in the middle (50-54 years) and older (60 years or more) age groups, this lipid metabolism disorder was observed with greater frequency among females. In addition, 68,9% of the respondents had elevated LDL-C levels. When studying the prevalence of this type of dyslipidemia in different age groups among men and women, a similar trend can be noted with similar TC values, but significant gender differences in the prevalence of elevated LDL-C levels l were revealed only in the 60-64 and 65-69 years groups. The prevalence of HTG among the adult population of the Nizhny Novgorod region was 42,6%. Among the 35-49 years and 55-59 years age groups, the prevalence of elevated TG levels was significantly more common among men. The incidence of decreased HDL-C levels was 13,3%. This type of dyslipidemia was significantly more often detected among men only in the youngest subgroup (35-39 years).Conclusion. Among the population of the Nizhny Novgorod region, hypercholesterolemia occurred in 65,1% of respondents, an increased level of LDL-C — in 68,9%, a HTG — in 42,6%, a reduced level of HDL-C — in 13,3%. The data obtained determine a high cardiovascular risk and require the development of prevention and treatment measures for lipid metabolism disorders.

BACKGROUND: The role of antidiabetic drugs in inpatient with COVID-19 and type 2 diabetes mellitus (T2DM) is usually considered in the context of target glycemiа maintaining. Except for insulin therapy sulfonylurea may be used in moderate COVID-19. The use of original gliclazide MR has advantages due to low risk of hypoglycemia and established cardio- and nephroprotective effects. But it is not clear whether the choice of antidiabetic drugs during hospitalization may affect patient’s condition in post-COVID period.AIM:. To assess the 12-month dynamics of carbohydrate metabolism in patients with T2DM after hospitalization for COVID-19 considering the character of hypoglycemic therapy in the hospital and the use of gliclazide MRMATERIALS AND METHODS: A 12-month prospective study was performed; T2DM patients were observed after hospitalization for COVID-19. They received in hospital: 1) original gliclazide MR (Diabeton MR, n=20) and 2) insulin (control group, n=20). Changes in antidiabetic therapy, glycemic control and biochemical tests were assessed at baseline and after 3, 6, 12 months. RESULTS: In the main and control groups the intensification of T2DM therapy was observed: the proportion of patients without hypoglycemic drugs decreased within a year by 3.0 (p = 0.001) and 2.8 (p =0.010) times respectively. Mean HbA1c values,the dynamics of inflammation markers and transaminases in both groups were similar (p>0.05 at all visits). Blood creatinine was at baseline 82.9±18.67 and 120.9±45.52 µmol/l (p=0.010), after 3 months — 88.0±18.77 and 104, 5±17.99 µmol/l (p=0.024), after 6 months — 89.3±12.17 and 97.5±9.03 µmol/l (p=0.072), after 12 months — 86.7±10.50 and 93.9±16.76 µmol/l (p=0.16). According to the data obtained during «3 months» visit, the dose of original gliclazide MR was directly correlated with the improvement in renal function in terms of glomerular filtration rateGFR (R=0,59, р=0,010). In addition, there was a close-to-significance correlation between continued gliclazide MR at visit 3 and improvement in GFR at visit 6 (R=0.31, p=0.076).CONCLUSION: The post-hospital period in patients with COVID-19 and T2DM was characterized by a tendency to hyperglycemia and increased need for hypoglycemic therapy. The use of original gliclazide MR by in patients with moderate COVID-19 and T2DM is appropriate and safe in terms of clinical and metabolic parameters dynamics during long-term post-hospital follow-up. When original gliclazide MR is continued during the post-hospital period its nephroprotective properties may contribute to the process of renal functions normalization which should be confirmed by further research.

Statins have diabetogenic properties. Pitavastatin is currently considered the only drug in this group that combines high lipid-correcting activity with the absence of a negative effect on carbohydrate metabolism. The article presents a case of correction of carbohydrate metabolism indicators against the background of pitavastatin therapy in a patient with dyslipidemia and impaired fasting glycemia. The optimal algorithms for the examination and treatment of such patients are discussed on the example of this patient.

Objective. To assess the prevalence of hypertension (HTN) in the population of the Nizhny Novgorod region and its relationship with hyperuricemia (HU) and other cardiovascular risk factors. Design and methods. We examined 2501 people aged 35–74 in the population of the Nizhny Novgorod region, selected by the stratified multi-stage random sample. All respondents underwent a laboratory study of the following parameters: total cholesterol, low-density lipoproteins (LDL), high-density lipoproteins, triglycerides (TG), fasting glucose, creatinine, uric acid, highly sensitive C-reactive protein (Hs-CRP) and fibrinogen. We also calculated body mass index (BMI), visceral obesity index with Amato formula and glomerular filtration rate with CKD-EPI formula. Binary logistic regression method was used to construct a predictive model for the risk of HTN. Statistical analysis was performed with IBM SPSS Statistics 26 software (USA). Results. HU was identified in 29,3 % of respondents with HTN. The mean uric acid level in this group was 345,1 [285,6; 410,55] µmol/l and significantly differed from the same indicator in residents without HTN — 297,5 [249,9; 351,1] µmol/L (p < 0,001). In the multiple logistic regression model, the most significant factors associated with HTN were age over 53 years (odds ratio (OR) 2,954, 95 % confidence interval (CI) 2,456-3,554 p < 0,001), abdominal obesity (OR 2,112, 95 % CI 1,663-2,730, p < 0,001) and HU (OR 1,709, 95 % CI 1,341–2,177, p < 0,001). A lesser contribution was made by such factors as the respondents’ BMI over 25 kg/m² (OR 1,634, 95 % CI 1,262–2,117, p < 0,001), elevated TG level (OR 1,567, 95 % CI 1,289–1,906, p < 0,001), male gender (OR 1,553, 95 % CI 1,281–1,883, p < 0,001), elevated Hs-CRP (OR 1,498, 95 % CI 1,242–1,806, p < 0,001), elevated LDL (OR 1,277, 95 % CI 1,038–1,570, p = 0,020). Conclusions. The results of the study indicate the widespread prevalence of HU in residents of the Nizhny Novgorod region with HTN: almost every third (29,3 %) had this disorder. In a multiple logistic regression model, HU was found to be highly correlated with HTN (OR 1,709, 95 % CI 1,341–2,177, p < 0,001), along with traditional cardiovascular risk factors such as male gender, age, overweight and obesity, lipid metabolism disorders. The high frequency of HU, its independent correlation with HTN, and the prospects for urate-lowering therapy in the prevention of cardiovascular diseases determine the need for further research.