Efficacy of taking ACE inhibitors and direct anticoagulants for coronary heart disease

Efficacy of taking ACE inhibitors and direct anticoagulants for coronary heart disease

Efficacy of an ACE inhibitor (ACE inhibitor) in coronary heart disease (CHD). There is ample evidence of the benefits of an ACE inhibitor in individuals with a high risk of coronary heart disease (CHD). After myocardial infarction (MI), an ACE inhibitor is associated with a 7% decrease in mortality by day 30 of the disease. Among patients with myocardial infarction with low EF, the decrease in total mortality is 26%.

A meta-analysis of 6 randomized controlled trials showed that long-term therapy with an ACE inhibitor reduces the risk of major clinical outcomes by 22%. The NORE study revealed that the benefits of an ACE inhibitor apply to patients with CHD and DM, even in the absence of LV dysfunction. The results of the CHARM (Candesartan in Heart Failure Assessment of Mortality and Morbidity) study showed that the use of ARBs of candesartan in patients with HF can prevent 1 death in the treatment of 63 patients, 1 first hospitalization for HF in the treatment of 23 patients and 1 new case of diabetes in the treatment of 71 patients.

Efficacy of direct anticoagulants for coronary heart disease (CHD). Per os anticoagulants prevent embolic complications in patients with prosthetic heart valves and atrial fibrillation. The role of the anticoagulant as an independent drug or in combination with aspirin in the secondary prevention of patients with coronary heart disease (CHD) is less defined.

The results of randomized controlled trials are ambiguous, anxious is such a side effect (PE) of anticoagulants as bleeding.

The 1999 meta-analysis provided comprehensive data on the different efficacy of treating patients with cardiovascular disease (CVD) with anticoagulants of varying intensity in combination with aspirin or aspirin alone as compared with placebo. In this analysis, it was shown that treatment with moderate or high intensity anticoagulants reduced the incidence of MI and MI compared to placebo, but increased the risk of hemorrhage.

The combination of low-intensity anticoagulants with aspirin did not lead to an increase in efficacy compared with aspirin alone, while a combination treatment with moderate-to-high-intensity anticoagulants with aspirin gave promising results. However, a recent analysis included the results of more recent studies of CHAMP (Cardiac Hospitalization Atherosclerosis Management Program), LoWASA (Low-dose warfarin and aspirin), WARIS II (Warfarin-Aspirin Reinfarction Study) and ASPECT-2 (Antithrombotics in the Secondary Prevention of Events in Coronary Thrombosis) led to the conclusion that moderate to high intensity anticoagulants should not be used routinely as an alternative or aspirin supplement in patients with acute coronary syndrome (ACS) because of the increased risk of bleeding.

Additional clinical studies are needed comparing the effectiveness of a combination of anticoagulants with clopidogrel. c) Recommendations. Aspirin should be used to treat all patients with various forms of coronary artery disease. The combination of aspirin with another anti-platelet drug, such as clopidogrel, should be used only in acute situations when treating patients at very high risk.

β-AB should be considered for the treatment of patients after MI or with HF. An ACE inhibitor should be considered a standard cost-effective therapy for patients with low EF and other high-risk patients. All three classes of the drug are recommended by AHA, ACC and ESC for secondary prophylaxis. The USPSTF recommended aspirin for primary prophylaxis in patients with a 5-year risk of CVDs> 3% (equivalent to 6% of a 10-year risk).

Per os anticoagulants, although they are clearly useful in the treatment of patients with AF and certain prosthetic heart valves, are not recommended for the general prevention of KBS-related events.

The effectiveness of physical training for coronary heart disease

The effectiveness of physical training for coronary heart disease

The prevalence of low physical activity (NFA). NFA is one of the most frequently occurring modifiable RFs. National Health Interview Survey data showed that 70% of American adults do not follow current guidelines for 30-minute mild or moderate physical activity (FA) for at least 5 days a week or intense physical activity (FA) for at least 20 minutes 5 days a week.

About 25% do not engage in any physical activity (FA) in their free time, while women lead a more sedentary lifestyle compared to men. The lack of sufficient FA is also common in children. Only a small number of schoolchildren have daily physical education classes, and children have had less time spent walking and cycling. On the contrary, the time spent on such sedentary activities, such as watching TV, computer games, has increased dramatically. It is unlikely that older people, most of whom are at risk for CVD, will be more physically active than the young.

All of these demographic changes have led to an increase in the incidence of diabetes among children, so diabetes mellitus-2 is no longer considered an adult disease.

Associated with low physical activity (NPA) risk. Results> 40 observational studies revealed a clear inverse linear dose-dependent relationship between FA and OS of men and women of younger and older. The results obtained in the mid-1950s showed that the frequency of KBS was lower for bus and postman conductors compared with slow-moving bus drivers and postal managers. Having included the evaluation of FA in their free time from work, the researchers found that employees who were engaged in intensive sports had MI 2 times less often than employees who were not involved in these activities. Later, in a number of observational studies, the same inverse relationship was found between the degree of FA at work or sports and KBS.

Minimal adherence to modern recommendations on physical activity (FA), which is accompanied by costs of 1000 kcal / week, is associated with a significant reduction in the risk of OS by 20-30%. A 1990 meta-analysis of 27 observational cohort studies revealed that the risk of KBS among people with a sedentary lifestyle after control of other RFs is almost 2 times higher than that of physically active people. Long-term, prospective studies of men and women have shown that FA protects against legal outcome in CHD.

For this, a simple fast walk is sufficient, which, as has been shown, reduces the risk of CHD in women and men, as well as the risk of diabetes mellitus 2. Even in a later period of life, the transition from a sedentary lifestyle to a more active one leads to a decrease in mortality from KBS. FA is also associated with a reduced risk of MI in men and women, primarily due to its beneficial effect on serum MT, BP, serum glucose tolerance and glucose tolerance.

Although there are no large-scale randomized studies of physical activity (FA), a number of studies have been conducted of moderate size and duration among healthy individuals and CVD patients. Despite differences in design, these studies have generally demonstrated the benefit of FA. However, the FA of ideal intensity, frequency, and duration has not yet been determined.

Benefits of Weight Loss and Obesity Treatment

Benefits of Weight Loss and Obesity Treatment

There are no large-scale randomized studies of isolated weight loss (MT) interventions to evaluate the effect of this reduction on reducing the risk of CHD. However, there is enough information from a number of observational studies and small randomized clinical trials for the duration to conclude that a decrease in MT brings significant health benefits. A small (by 5-10%) decrease in MT is associated with a significant improvement in blood pressure in individuals with and without AH. A small decrease in MT improves the lipid profile, reducing the level of TG, increasing the level of HDL cholesterol and slightly reducing cholesterol and LDL cholesterol, as well as increasing glucose tolerance and / or TS. Reducing MT also helps relieve sleep apnea.

However, there is no consistent approach to reducing MT, and the results of lifestyle modifications to reduce MT are disappointing. In the USA, 25% of men and 43% of women try to reduce MT during the year, but the rate of failed attempts is very high. One of the reasons may be that most people trying to reduce MT do not follow recommendations to reduce calorie intake and increase physical activity (FA) to at least 150 minutes a week.

Effective treatment strategies are usually multifaceted, including nutritional counseling, behavioral therapy, increasing FA and psychosocial support. Recent observational and clinical studies have shown that pharmacotherapy and bariatric surgery may be helpful in reducing MT, but long-term success and risk, as well as the cost-effectiveness relationship, have not been fully evaluated.

The ratio of cost-effectiveness. The lack of benefit assessments and the large variability of intervention strategies do not allow an assessment of the cost-effectiveness ratio of programs or interventions to reduce MT.

Recommendations and guidelines. The guidelines developed by the National Heart, the Lung and Blood Institute and the North American Association for the Study of Obesity offer a threefold strategy for reducing MT, which includes calorie restriction, structured physical activity (FA) and behavioral therapy for all patients with an IMT of> 30 kg / m2, for patients with BMI = 25.0-29.9 kg / m2, suffering from CHD or having RF> 2 (see further discussion of interventions using specific FN and nutritional recommendations). For some patients, pharmacotherapy is suitable, and for very obese patients – bariatric surgery.