Aim. To evaluate severity and pattern of structural and functional changes of vascular wall in early postmenopausal women receiving chronic treatment with a low-dose combination of 17ß-estradiol (E2) 1 mg and drospirenone 2 mg (DRSP). Evaluation of structural and functional arterial remodeling might be important for assessment of cardiovascular risk in postmenopausal women. Materials and methods. The study included 162 early postmenopausal women with postmenopausal syndrome. The women were divided into two groups. The main group consisted of 84 patients receiving the postmenopausal hormonal therapy (PMHT) with E21 mg/DRSP 2 mg (Angeliq, Bayer) and the control group included 78 women not receiving PMHT. The follow-up duration was 5.2 years. 24-h blood pressure monitoring with evaluation of arterial stiffness (RWTT, AIx, ASI, AASI, (dP/dt)_max) was performed. Endothelium-dependent dilation of the brachial artery was measured using the reactive hyperemia test. Aortic pulse wave velocity (aPWV) and common carotid intima-media thickness (ccIMT) were measured ultrasonically. Results. At baseline, increased aPWV was observed in 15 (21.4 %) women of the main group and 19 (24.3%) women of the control group (р=0.4). At the end of study, increased aPWV was observed in both groups but the increase was more pronounced in the control group. Increased pulse blood pressure (PBP) was observed in 27 (32.1%) patients of the main group and 26 (33.3%) patients of the control group (р=0.87). At the end of study, PBP decreased from 47.2±7.2 to 45.3±6.9 mm Hg (р<0.01) in the main group and remained unchanged in the control group. Aix was significantly increased in the control group and unchanged in the main group. ASI values changed in opposite directions at the end of study; they were decreased from 132.0 (121.0; 142.0) to 127.0 (115.5; 137.0) units in the main group and increased from 133.0 (111.0; 155.0) to 148.0 (134.2; 171.0) units in the control group (р<0.01). At the end of study, AASI values decreased in the main group from 0.379 (0.320; 0.463) to 0.264 (0.203; 0.329) units (р<0.001) and remained unchanged in the control group. The endothelial function improved in the main group; endothelium-dependent vasodilation of the brachial artery was increasing throughout the follow-up period while it remained unchanged in the control group. An increased ccIMT was found in one third of examined women. In the main group, ccIMT did not change during the follow-up period while in the control group, ccIMT was increased at the end of study (p<0.05). Conclusion. Evaluation of arterial structural and functional remodeling might be important for assessment of cardiovascular risk in postmenopausal women. The combination treatment with E21 mg/DRSP 2 mg PMHT was associated with beneficial changes in the arterial wall structure and function.

The article focuses on practical aspects of managing patients with a frequently observed combination of atrial fibrillation (AF) and chronic kidney disease (CKD). Based on the authors» own data taken as an example, incidence of different CKD stages in CKD patients was compared with international reports. EchoCG changes were shown to be related with CKD severity. Antithrombotic prevention administered to such patients in the settings of real practice was compared with the existing guidelines.

The review analyzes the reports addressing from different standpoints the issue of stent thrombosis and its major predictors in patients with acute coronary syndrome following transcutaneous coronary interventions. The review focuses on comparative efficacy and safety of ticagrelor and clopidogrel and the effect of double antiplatelet therapy on stent thrombosis. The issue of patients’ compliance with double antiplatelet therapy is also discussed. Such comprehensive evaluation is warranted since despite all efforts for expanding both technical and therapeutic possibilities, the issue of stent thrombosis remains relevant.

The review analyzed current ideas on prevalence and clinical significance of atrial fibrillation following acute coronary syndrome; described modern approaches to administration of antithrombotic therapy; and addressed available clinical studies on the treatment with warfarin and new oral anticoagulants as a part of combination antithrombotic therapy in patients with atrial fibrillation and acute coronary syndrome.

Hypertrophic cardiomyopathy (HCM) is a disease with left ventricular hypertrophy caused by mutations in the genes of myocardial contractile proteins, whose frequency is about 0.5%. Due to the high incidence of anginal pain and marked changes in ECG with HCM, the problem of diagnosing the combination of HCM and coronary artery disease (CAD) presents a rather difficult task for the clinician. The complexity of this diagnosis is due to the ability of standard methods of instrumental examination (ECG, a test with physical activity, stress tests in conjunction with visualization of the myocardium) to detect myocardial ischemia in both CAD and HCM. In such cases, the coronary angiography, or multispiral computed tomography of coronary arteries (in patients with low CAD risk) remains the gold standard for detecting atherosclerotic lesions of the coronary arteries. The possibility of combining HCM and CAD in patients of older age groups raises the question of the features of the course of diseases and the prognosis of such patients.

Acetylsalicylic acid (ASA) has a 120-years long history. First ASA was used as an antipyretic and anesthetic medicine, nowadays it is widely prescribed to patients with coronary arteries disease as antithrombotic cure for prevention of major adverse clinical events (MACE). Though there are a lot of trials about usage of ASA for first and secondary MACE prevention still there are unmet clinical needs - dosage choice, the therapy length, diagnostic and management of ASA resistance, and also the prophylaxis of gastro-enteric hemorrhages.

Atrial fibrillation (AF) represents the most frequent sustained cardiac arrhythmia, the prevalence of AF is 1-2% in the general population and up to 6% for population over 80 years. Arterial hypertension (AH) is the commonest background comorbidity in patients with AF. Patients with AF have 3-6-fold increased risk of ischemic stroke in comparison to that in general population, additionally the presence of AH leads an 2-3-fold increase in risk of subsequent stroke. Current clinical guidelines recommend long-time anticoagulant treatment for prevention of stroke and thromboembolic complications in majority of patients with confirmed AF. Not only does uncontrolled high blood pressure contribute to developing new-onset AF or AF progression but also can increase a bleeding risk related to oral anticoagulants. Patients with AF and concomitant AH resulting in target organ damage need for more favorable safety profile of oral anticoagulants. Instruction label dabigatran treatment in two doses can individualize approach to choice of long-term anticoagulation with lower risk of major bleeding in AF patients.