CardioSomatics

The presented expert paper discusses the high prevalence of hypercholesterolemia (HCH) in Russia. Insufficient use of lipid-lowering therapy in both primary and secondary prevention is indicated. Failure to achieve the target level of low-density lipoprotein cholesterol (HC) and low adherence (especially long-term) of patients to hypolipidemic drugs remains a serious problem in real clinical practice. Statins are a class of widely prescribed lipid-lowering drugs that are the first choice drugs in the treatment of HCV and combined hyperlipidemia (GLP) with proven efficacy in the prevention of atherosclerotic cardiovascular diseases. Using the example of the original pitavastatin, this expert document convincingly demonstrates the drug's capabilities not only in reducing atherogenic lipids and lipoproteins in blood plasma, but also its clinical effectiveness in the primary and secondary prevention of cardiovascular complications. This highlights the unique effect of pitavastatin on increasing low cholesterol levels of high-density lipoproteins, proven anti-atherosclerotic activity and a wide range of positive pleiotropic effects that enhance its antiatherogenic effect. The low risk of drug interactions inherent in pitavastatin highlights its high safety with prolonged use and good tolerability. All of the above gives grounds to consider the original pitavastatin as the drug of choice for a wide range of patients.

This article was previously published in: Bubnova MG, Galyavich AS, Ezhov MV, Aronov DM, Vinogradova NN, Galstyan GR, Gurevich VS, Karpov YuA, Koziolova NA, Kosmacheva ED, Matyushin GV, Sergienko IV, Filippov AE, Khalimov YuSh. The place of original pitavastatin in primary and secondary prevention of cardiovascular diseases. Interdisciplinary Expert Consensus of the Russian Society of Cardiology, the National Atherosclerosis Society, the Russian Society of Cardiosomatic Rehabilitation and Secondary Prevention, and the Russian Association of Endocrinologists. Russian Journal of Cardiology. 2024;29(11):6148. doi: 10.15829/1560-4071-2024-6148. EDN: PSIJPF

The article was published with the consent of the author's team and the editorial board of the Russian Journal of Cardiology and does not contradict the Creative Commons Attribution 4.0 License.

BACKGROUND: Thyroid disorders, including hyperthyroidism and hypothyroidism, are prevalent worldwide, affecting millions. Both thyroid hormone and vitamin D status regulate lipid metabolism, maintain cellular function via steroid receptors, and may influence each other's actions through similar gene response areas.

AIM: This study aims to compare the lipid profile and vitamin D status levels in patients with thyroid disorders to those of healthy controls.

MATERIALS AND METHODS: This cross-sectional, descriptive study included 225 individuals: 76 with hyperthyroidism, 75 with hypothyroidism, and 74 healthy controls. Blood serum samples were analyzed for concentrations of Thyroid-Stimulating Hormone (TSH), Free Triiodothyronine (FT3), Free Thyroxine (FT4), lipid profile, and 25-Hydroxyvitamin D (25(OH)D.

RESULTS: Hypothyroidism patients exhibited significantly higher mean values of TSH (26.29±14.89 mU/L; p <0.001), BMI (24.16±3.62 kg/m²; p <0.001), total cholesterol (TC) (220.23±26.41 mg/dL; p <0.001), triglycerides (TG) (134.53±21.37 mg/dL; p <0.001), low-density lipoproteins (LDL) (144.6±25.53 mg/dL; p <0.001), very-low-density lipoproteins (VLDL) (26.90±4.27 mg/dL; p <0.001), and non-HDL cholesterol (157.50±29.63 mg/dL; p=0.032) compared to controls and hyperthyroidism patients. They also exhibited significantly lower mean levels of FT3 (0.535±0.71 ng/mL; p <0.001) and FT4 (10.95±6.41 pmol/L; p <0.001). Vitamin D levels were lower in hypothyroidism patients (25.30±13.69 ng/mL; p=0.035) compared to healthy controls (29.43±16.37 ng/mL) but higher than hyperthyroidism patients (23.02±15.55 ng/mL). A majority (60%) of hypothyroidism patients were vitamin D deficient (<20 ng/mL; p <0.001).TSH showed a significant positive correlation with lipid parameters (p <0.05) except for High-Density Lipoprotein Cholesterol (HDL-C), which was inversely correlated. Vitamin D levels demonstrated a significant positive correlation with HDL-C across all groups (p <0.05).

CONCLUSIONS: The study concludes that thyroid disorders are closely associated with vitamin D levels and lipid metabolism. There is a confirmed link between vitamin D, lipid profile, and cardiovascular risks in patients with thyroid disorders.

BACKGROUND: Complete left bundle branch block is a classic example of an electrocardiogram that is non-informative when assessed using conventional criteria for myocardial ischemia. QRS duration is an established electrocardiographic marker of ventricular dyssynchrony and is used to predict the clinical course of chronic heart failure. Fragmented QRS, a less studied electrocardiographic parameter that reflects myocardial scarring, has emerged as a negative prognostic marker in coronary artery disease, being associated with recurrent cardiovascular events, hospitalizations, and mortality in patients with narrow QRS complexes. However, data on the value of fragmented QRS in the setting of wide QRS complexes remain limited.

AIM: To conduct a comparative analysis of the clinical, instrumental, and epidemiologic characteristics of patients with coronary artery disease and complete left bundle branch block, with consideration of the fragmented QRS presence.

MATERIALS AND METHODS: The study included 45 hospitalized patients with coronary artery disease (mean age 76±8 years). The main group consisted of 10 patients with fragmented QRS, and the control group included 35 patients without fragmented QRS. At the first stage (2018–2019), clinical history, electrocardiographic parameters, and echocardiographic characteristics (global and regional left ventricular contractility) were assessed. At the second stage (2024), medical records were analyzed using the Unified Medical Information and Analytical System.

RESULTS: Patients in the main group had longer QTc intervals (463 vs 433 ms in the control group; p=0.028), wider QRS complexes (160 vs 120 ms; p=0.009), and slightly lower left ventricular ejection fraction (34.2±14.4% vs 42.8±13.9%; p=0.063). The groups differed significantly in the severity of chronic heart failure (p=0.043), with stage 2B CHF (CHF was assessed using the Strazhesko classification which is commonly applied in clinical practice in Eastern Europe and Russia) observed in 80% of the main group vs 49% of the control group. The median number of fragmented leads was 4.5. Cardiovascular-related hospitalizations were slightly more frequent in the main group (p=0.061). A total of 27 deaths were recorded, most due to noncardiac causes. Death due to progression of chronic heart failure occurred in 30% of the main group and 17.1% of the control group. There were no significant differences in the mortality structure between groups.

CONCLUSION: The presence of fragmented QRS complexes on electrocardiogram in patients with complete left bundle branch block is associated with further QRS widening and QTc prolongation, a trend toward reduced left ventricular ejection fraction, increased frequency of cardiovascular-related hospitalizations, and progression of heart failure severity. These findings may be considered in the development of prognostic models for patients with coronary artery disease and initially abnormal QRS complexes.

BACKGROUND: Iron deficiency anemia is one of the most common conditions worldwide and ranks first in prevalence among women of reproductive age. Conventional iron formulations are frequently associated with a high incidence of adverse effects. Therefore, there is a need to identify novel iron compounds that offer improved tolerability without compromising efficacy.

AIM: To compare the outcomes of dietary correction in nonpregnant women receiving iron bisglycinate vs those receiving iron sulfate.

MATERIALS AND METHODS: The study included 120 women of reproductive age (18–49 years) with mild iron deficiency anemia who met the inclusion criteria. Patients were randomized into 2 groups. The main group received the investigational product containing 30 mg of elemental iron in chelated bisglycinate form combined with vitamins C, B₆, B₁₂, and L-methylfolate (the dietary supplement VitaFerr), administered as 1 capsule once a day with food. The control group received a preparation containing 100 mg of elemental iron as sulfate combined with 60 mg of vitamin C, taken as 2 tablets per day. The total duration of therapy was 60 days.

RESULTS: After adjustment for baseline hemoglobin levels, the proportion of female patients who achieved the target hemoglobin level was 88.9% in the main group and 94.3% in the control group (p=0.240). No statistically significant between-group differences were observed in hemoglobin, ferritin, or serum iron levels after 60 days (p >0.05), indicating comparable efficacy of the treatment regimens. The study showed that a daily dose of 30 mg of iron bisglycinate significantly increased serum ferritin levels — from 24.1 to 32.3 ng/mL by day 15, with a mean ferritin concentration of 39.1 ng/mL on day 60 (p <0.001). A statistically significant difference in the frequency of adverse events was observed between groups: 16 (26.7%) in the main group and 37 (61.7%) in the control group (p <0.001).

CONCLUSION: The dietary supplement VitaFerr may be considered an effective and safe option for the prevention and treatment of iron deficiency and anemia.

BACKGROUND: Maintenance hemodialysis remains the most common modality of renal replacement therapy, with a consistently high demand. Despite technological advances in recent decades, this high-cost treatment is still associated with a substantial mortality rate. Currently, numerous parameters linked to poor prognosis have been identified, among which skin autofluorescence represents an accessible method for assessing tissue accumulation of glycation end-products (glycotoxins).

AIM: To determine the prognostic value of skin autofluorescence and its associations with clinical parameters and metabolic disturbances in patients undergoing maintenance hemodialysis.

MATERIALS AND METHODS: A total of 88 patients (47 men) undergoing maintenance hemodialysis were prospectively observed over a mean period of 49 months. The mean age was 58.01±13.79 years. Skin autofluorescence was noninvasively assessed using a specialized reader. All-cause mortality was selected as the primary endpoint.

RESULTS: A significant increase in skin autofluorescence was confirmed in patients receiving maintenance hemodialysis. Skin autofluorescence was found to be determined (R²=46%) by the Charlson comorbidity index, duration of tobacco use (in years), and serum potassium levels. Skin autofluorescence demonstrated statistically significant correlations with parameters of left ventricular hypertrophy and negative correlations with left ventricular ejection fraction. Death occurred in 38 patients, most commonly due to acute cardiovascular failure (23 patients, 61%). Baseline skin autofluorescence level, combined with serum albumin, alkaline phosphatase, and C-reactive protein levels, yielded a prognostic model for all-cause mortality with 72% sensitivity and 84% specificity. A model incorporating skin autofluorescence changes achieved 89% sensitivity, 91% specificity, and 89.9% predictive accuracy.

CONCLUSION: The findings support the use of skin autofluorescence as an integral, independent predictor of all-cause mortality in patients undergoing maintenance hemodialysis. Skin autofluorescence reflects inflammatory and metabolic status, electrolyte imbalances, and cardiovascular remodeling.

BACKGROUND: Publications on rehabilitation in patients following heart transplantation remain limited. This issue is currently being actively investigated, as there is a lack of clear data on the optimal timing for initiating physical rehabilitation, the use of exercise testing for objective assessment of patient condition, or the types of physical training.

CASE DESCRIPTION: This case study describes the positive effects of early rehabilitation in a patient after orthotopic heart transplantation.

CONCLUSION: Patients who underwent heart transplantation have a greater potential for restoring cardiovascular function compared with other categories of patients with cardiovascular diseases treated surgically. However, these patients also face factors that may limit the rapid recovery of functional capacity and quality of life. While most studies have demonstrated the effects of various types of physical training during the outpatient phase, this case report highlights the positive outcomes of initiating cardiac rehabilitation in the early postoperative period. These findings may support a revision of current approaches to the timing of rehabilitation in this patient population.