The article discusses the effectiveness and safety of oral anticoagulants in elderly patients with non-valvular atrial fibrillation. The results of randomized controlled trials of RE-LY, ROCKET-AF, ARISTOTLE and ENGAGE AF-TIMI48, including subgroup analysis in patients over 75 years of age, in patients with renal dysfunction and a high risk of gastrointestinal bleeding, are given recommendations for optimal choice oral anticoagulant in these patient categories. The main provisions of the FORTA consensus document are also considered, the purpose of which is to individualize the treatment of elderly patients on the basis of clinical characteristics of the patient, taking into account possible mistakes in the use of medicines. The interdisciplinary expert council of FORTA considers apixaban to be the safest anticoagulant in elderly patients.

The article discusses the possibility and the evidence base for the use at a fixed dose of a domestic combined antihypertensive drug Gipotef, consisting of enalapril (5 mg), indapamide (0.75 mg), metoprolol tartrate (25 mg) and vinpocetine (2.5 mg). According to the mechanism of its action, Gipotef affects various links in the pathogenesis of arterial hypertension and has an additional cerebroprotective effect.

In the review, based on modern literature data and own clinical observations, the methods of clinical and instrumental diagnostics of vasospastic angina pectoris, its difficulties are described in detail; the pathogenetic nature of this form of ischemic heart disease is presented. The possible current methods of therapy are given.

The Aim. To assess the diagnostic value of markers of damage to the vascular wall and proinflammatory cytokines in the exacerbation of coronary heart disease on the basis of a comparative study of these indicators and their relationship in patients with different clinical forms of IHD. Materials and methods. The study included 164 patients with ischemic heart disease: a group of 40 patients with myocardial infarction (MI) with ST-segment elevation (IMweST), 36 patients with MI without ST-segment elevation (IMw/oeST), 33 patients with unstable angina (NS) and 55 people with chronic forms of ischemic heart disease. The control group consisted of 30 patients with AH without signs of IHD. All patients with ACS were assessed for the level of proinflammatory cytokines TNF-а, IL-1, IL-6 and AT to c-GAG in the dynamics of inpatient treatment. In the HIBS and control group the level of cytokines and ATs to c-GAG was determined singly upon admission. Results. In patients with acute forms of ischemic heart disease (MI and HC), a significant increase in the level of circulating antibodies to c-GAG and cytokines studied was found in comparison with the HIBS group. At the same time, with HIBS, the parameters studied were higher than in the control group. Correlation analysis in the general group of patients with ACS revealed a strong relationship between the level of antibodies to GAG and IL-6, the relationship between the average strength between the level of antibodies to GAG and IL-1; between the level of antibodies to GAG and TNF-а. In patients with MI, the correlation between the parameters studied was stronger than in patients with UA. In patients with HIBS, no statistically significant relationship between antibodies to c-GAG and cytokines was detected. Standard therapy of ACS led to a decrease in inflammatory markers and a level of antibodies to c-GAG, but these indicators did not reach the level of the control group (persons without IHD). It was shown that an increased level of proinflammatory cytokines and AT to c-GAG is characteristic not only for necrotic damage of the myocardium, but also arises in patients with HC at the stage of myocardial ischemia, significantly exceeding the similar indices in the HIBS group. The conclusion. Exacerbation of IHD is associated with an increase in the level of circulating pro-inflammatory cytokines and antibodies to connective tissue components. The relationship between the content of antibodies and pro-inflammatory cytokines confirms the pathogenetic role of immune inflammation in the development of ACS. The results obtained are of practical interest, since they allow us to objectify the diagnosis of ACS at the stage of unstable angina.

Aim: to assess the frequency and structure of adverse outcomes in patients with acute coronary syndrome without ST segment elevation, depending on the presence of type 2 diabetes at follow-up of one year. Materials and methods: 153 patients with acute coronary syndrome without ST segment elevation were included in the prospective study from March 2014 to January 2017. All patients were divided into two groups: group 1 - with the presence of type 2 diabetes (n = 44 (28.7 %)), the annual follow-up was evaluated in 40 (90.9 %) patients. The second group included 109 (71.2 %) patients without type 2 diabetes, the annual follow-up was evaluated in 99 (90.8 %) patients. Adverse outcomes during one year follow-up such as cardiovascular mortality, nonfatal myocardial infarction, nonfatal acute cerebrovascular accident, hospitalization for unstable angina, decompensation of chronic heart failure, as well as a combined endpoint, including all listed adverse outcomes have been evaluated in both patient groups. Results: there were no significant differences between the groups according to clinical and anamnestic characteristics at enrollment in the study. In the group of patients with type 2 diabetes, 5 (13.5 %) died for cardiovascular reason against 15 (15.8 %) patients in the group without diabetes, recurrent MI developed in 2 (5.9 %) of patients with type 2 diabetes and 7 (7.8 %) patients without diabetes, 3 (9.4 %) patients with type 2 diabetes and 4 (4.9 %) patients without diabetes were at least once hospitalized with HF decomposition. Non fatal acute stroke was revealed significantly more often (p = 0,008) in the patients group with type 2 diabetes-8 (21,6 %) against 5 (5,7 %) patients without type 2 diabetes (p = 0,008). The incidence of combined endpoint development was non-significantly higher (p = 0.12) in the group of patients with type 2 diabetes compared with that in patients without impaired carbohydrate metabolism. Conclusion: in type 2 diabetes patients after acute coronary syndrome without ST segment elevation nonfatal acute cerebrovascular accident developed in 20,0 % of cases which is significantly (p = 0,008) more often than in similar patients without diabetes (5,1 %). at one year of follow-up.