Cognitive impairments in cardiological patients: diagnosis and prevention


1Peoples Friendship University of Russia (RUDN University), Moscow, Russia;

2City Clinical Hospital named after V.V. Vinogradov, Moscow, Russia

3LLC «Scientific and production company «PHARMASOFT», Moscow, Russia

The development of preventive measures to reduce the risk of developing cognitive decline is named by WHO among the main priorities of medicine. Cardiovascular diseases and cognitive disorders, on the one hand, have similar risk factors, such as obesity, smoking, dyslipidemia, lack of physical activity, low education level, and, on the other hand, the presence of atrial fibrillation (AF), arterial hypertension (AH), cardiac insufficiency (HF), chronic kidney disease, diabetes mellitus contributes to the progression of cognitive impairment. In the era of patient-oriented medicine, when choosing the optimal treatment regimen for AH, AF, and HF, it is necessary to take into account the potential of certain therapy regimens in the prevention of cognitive impairment. This article is devoted to a review of existing therapeutic strategies to prevent the development of cognitive deficits in patients with a cardiological profile.
Keywords: cognitive impairment, dementia, arterial hypertension, atrial fibrillation, heart failure, mexidol.

Effects of mexidol in patients with chronic brain ischemia and chronic heart failure (II-III functional class)

1People’ Friendship University of Russia, Moscow, Russia;
2Pavlov Ryazan State Medical University, Ryazan, Russia

Aim. To study the effect of mexidol on N-terminal pro B-type natriuretic peptide (NT-proBNP), markers of oxidative stress, inflammatory reaction and endothelial dysfunction in patients with chronic brain ischemia and chronic heart failure II-III NYHA functional class while 13 weeks of sequential intravenous and oral therapy with mexidol and standard therapy. Material and methods. Study included 44 patients with chronic brain ischemia and chronic heart failure II-III NYHA functional class with ejection fraction less 50%. Mean age: 65.5±11.8 years, 75% men. 21 patients of group mexidol plus standard therapy of chronic heart failure received mexidol at a dose of 1000 mg/day by intravenous infusion for 7 days followed by oral doses of 250 mg three times a day for twelve weeks, 23 patients received standard therapy. 34 patients completed the trial, in 10 patient the final visit was performed as telephone call due to epidemiologic situation. Concentration of N-terminal pro B-type natriuretic peptide (NT-proBNP), markers of oxidative stress (malonic dialdehyde (MDA), superoxide dismutase (SOD)), inflammatory reaction (C-reactive protein (CRP), tumor necrosis factor α (TNFα)), homocysteine and cystatin C were examined in blinded manner in all patients initially, on day 7 and week 13. Results. Statistically significant more prominent decrease of NT-proBNP, MDA, CRP and TNFα and increase of SOD by day 7 and week 13 were observed in patients treated with mexidol along with standard therapy in comparison with group treated with standard therapy. Conclusion. Mexidol added to standard therapy of patients with chronic brain ischemia and chronic heart failure II-III functional class decreases concentration of NT-proBNP, has proven antioxidant activity, decreases the degree of inflammatory reaction, slows down the increase of homocysteine, does not influence the kidney function (by measurement of cystatin C).
Key words: chronic brain ischemia, heart failure, oxidative stress, antioxidants, N-terminal pro B-type natriuretic peptide (NT-proBNP), malonic dialdehyde, superoxide dismutase, CRP, TNFα, ethyl-methyl-hydroxipyridin succinate, mexidol.

Arterial hypertension, cognitive disorders and dementia: a view of a cardiologist

Moscow State University of Medicine and Dentistry named after A.I. Evdakimov, Moscow, Russia; I.M. Sechenov First Moscow State
Medical University, Moscow, Russia; Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia

This article presents a review of Russian and foreign literature about the impact of arterial hypertension (AH) on the risk of cognitive impairment and dementia. Large studies have demonstrated the effect of blood pressure (BP) on the risk of vascular dementia and Alzheimer’s disease (AD) in elderly and oldest old people as well as a role of antihypertensive therapy. There is evidence of a negative effect of hypertension in middle age on cognitive functions in late-life. Observational studies as a whole have shown the positive effect of antihypertensive therapy on the prevention of cognitive function and dementia. However, there are a number of limitations that dictate the need for further research on this issue. The importance of the interdisciplinary approach to treatment of cognitive impairment by cardiologists and/or therapists, together with neurologists, as well as complex treatment regimens, including correction of risk factors and neuroprotective therapy, is highlighted.

Keywords: arterial hypertension, cognitive impairment, dementia, Alzheimer disease, antihypertensive therapy.

Clinical aspects of ethylmethylhydroxypyridine succinate in elderly patients with cardiovascular pathology

Martemianova E. G.1,2
1LLC «Preobrazhenskaya Clinic». Ekaterinburg; 2LLC «IC Bivita». Ekaterinburg, Russia

Aim. To evaluate efficacy and safety of original ethylmethylhydroxypyridine succinate (Mexidol) in cardiological patients ≥75 year old. Material and methods. In the observational study, according to ethical standards of Khelsinki Declaration, with informed consent, 24 patients participated, age 75-88 y. o. Inclusion criteria: age ≥75 y. o.; already diagnosed coronary heart disease (CHD) and/or chronic heart failure (CHF); Mexidol usage. Exclusion criteria: absent informed consent, severe comorbidities. Mean age of the patients at inclusion 80,33±4,06 y. o.; 16 (66,7%) females and 8 (33,3%) males. Patients consequently visited office of cardiologist with the diagnoses: chronic CHD (I25.0-I25.9), CHF with preserved systolic function (I50.0-I50.9). All patients were consulted by neurologist, had an established diagnosis of cerebrovascular disease (I65-67). To reduce the symptoms of frailty, among the neurologist recommendations, with accordance to routine clinical practice, the original Mexidol was included. Mexidol was prescribed by a scheme of manufacturer: intravenous infusions 500 mg x 5 days, then per os 125 mg t. i.d.; overall treatment — 8 weeks. Results. Statistically significant results were noted in 6 months from the study start. There was significant increase of 6 minute walking distance in men from 304,00±87,09 to 388,63±92,28 m (р=0,01), in women from 346,06±56,81 to 427,69±76,87 m (р=0,003); also there were less signs of frailty. No one patient showed significant worsening of the condition; during the overall follow-up, patients did not call emergency or primary care physicians and did not hospitalize. Conclusion. In comorbidity patients aged ≥75 y. o. at Mexidol treatment, there was increase of 6-minute walking test distance, decrease of asthenia signs, that witness for the medication efficacy. All patients showed good tolerability of the drug that witness for safety. Obviously, there are broad trials needed to sum up a gerontological algorithm of CHD and CHF patient management in outpatient setting.

Keywords: Mexidol, heart failure, frailty.

Cytoprotective therapy for kidney injury in patients with ST-elevation myocardial infarction

1Federal State Budgetary Educational Establishment of Higher Training «Nizhny Novgorod state medical academy» of the Ministry of Public Health; 2Federal State Budgetary Educational Establishment of Higher Training «The Pirogov Russian National Research Medical University» of the Ministry of Public Health; 3State Budgetary Institution of Health Nizhny Novgorod region «Nizhny Novgorod Regional Clinical Hospital named after NA Semashko»

Aim. To study an effectiveness of mexidol (ethylmethylhydroxypyridine succinate) for kidney injury in patients with ST-elevation myocardial infarction (STEMI). Material and methods. The study involved 55 STEMI patients. Acute renal injury (ARI) was determined according to basal creatinine, serum creatinine, glomerular filtration rate, cystatin C and NGAL. In STEMI patients standard therapy was supplemented by antioxidant (cytoprotector) mexidol from the 1st to the 10th day 750 mg/day intravenously. ARI values were assessed after treatment. Results. There were 36 ARI patients among 55 patients with STEMI. Therapy with mexidol significantly decreased ARI severity (urine creatinine, cystatin C and NGAL values) after 48 hours. Conclusion. Mexidol may be used in addition to standard therapy in STEMI patients to reduce ARI severity.

Keywords: cytoprotectors, myocardial infarction, acute renal injury.

Mexidol influence on the parameters of infrared spectrometry of blood lipid complex in case of acute coronary syndrome

Tver State Medical Academy, Department of Internal Medicine and Department of Chemistry, FPAE

It was analyzed the mexidol influence on phospholipid metabolism in acute coronary syndrome (ACS). The study included 70 patients. Intravenous mexidol infusions were included in the complex therapy in 30 cases. Conventional clinical and laboratory data, as well as the absorption of lipid phospholipid complexes in the infrared spectrum of blood serum were evaluated. The study established a mechanism of phospholipids autoregulation as a wave-like fluctuations of their concentration in the blood serum with early increasing (compared with healthy) in the first hours and days of development of ACS. It was observed the maximum rise by the 4th day and a moderate decline by the 10 day of observation reflecting the degree of adaptation systems stress. Regardless on the clinical form of ACS mexidol application eliminates oscillatory nature of the phospholipids dynamics. It is stabilizing their rise at a level sufficient to ensure the power and plastic needs of the organism and myocardium that improves the results of combined treatment.

Keywords: acute coronary syndrome, homeostasis, phospholipids, mexidol, infrared spectrometry.

Antioxidant therapy in the correction of oxidative stress in the patients with coronary heart disease and type II diabetes

Voronezh State N.N. Burdenko Medical Academy

Abstract: the paper describes the study of the state of LP0‐AOD system in the patients with coronary artery disease and type 2 diabetes and the effect of antioxidant therapy on metabolic factors. Timely correction of disorders contributed to the positive dynamics of metabolic processes, and on the background of this, reduced frequency of cardiovascular complications.

Keywords: LP0‐AOD system, coronary artery disease, type II diabetes, antioxidant therapy, cardiovascular complications.

Mexidol in comlex therapy of a stable angina


It is carried out research of quality of life and alarm at 130 patients with stable angina FC II conditions of policlinic branch BUZOO City Clinical Hospital 4 Omsk. We have studied functional parameters at sick by a stable angina, influence of disease on quality of life. We have studied efficiency of preparation Mexidol in complex treatment of patients with a stable angina. We have developed the differentiated approach to pharmacotherapy in view of quality of life and a level of alarm of person.

Keywords: ischemic heart disease, stable angina, quality of life.

Role of antioxidants in treatment and prevention of patients with high risk of cardiovascular complications

Research Institute of Experimental and Clinical Medicine, Novosibirsk, Russia; Neurology Research Center, Mosсow, Russia

Aim — to estimate effect of Mexidol on blood lipids in patients with high cardiovascular risk and diabetes mellitus type 2 (DM2). Material and methods. Two groups of patients with DM2 as the main risk factor of vascular complications were prospectively followed-up within 3 months. Achievement of target blood lipid was compared in standard therapy with statins (group 1) and addition of Mexidol to basic therapy (group 2). Enzymatic colorimetric method was used to determine blood lipids level (Boehringer Mannheim, Germany). Results. There was a positive effect of Mexidol at the initial stage of statins therapy that was expressed by normalized lipids level in DM2 patients with high and very high cardiovascular risk.

Keywords: cardiovascular complications, diabetes mellitus type 2, dyslipidemia, prevention, Mexidol.